Nursing Home Residents Who Reject Care Require Screening

Article excerpt

LONG BEACH, CALIF. -- Rejection of care by nursing home residents was associated with four potentially modifiable factors in an analysis of data on 3,230 residents.

Clinicians should screen for the conditions - delusion, delirium, minor or major depression, and severe or worse pain - when residents reject care such as taking medications and accepting assistance with activities of daily living, Dr. Shinya Ishii and associates reported in the top prize-winning poster presentation at the meeting.

If the associations observed in the study are causal, appropriate interventions may improve residents' willingness to accept care, the researchers suggested. The team analyzed data on residents scheduled for Minimum Data Set assessments in 71 nursing homes in eight states. Nurses identified residents who were rejecting care.

The likelihood of doing so increased fourfold in the presence of delusion and doubled in the presence of delirium, depression, or severe-to-horrible pain, reported Dr. Ishii of the Department of Veterans Affairs' geriatric research education and clinical center, Los Angeles.

Among the 312 residents who exhibited rejection-of-care behaviors, 18% had delusions, 35% had delirium, 32% had minor depression, 15% had major depression, and 30% had severe to "horrible" pain. Some symptoms overlapped. An attributable-risk analysis suggested that 19% of care-rejecting behavior could be eliminated if delusions were stopped and that 5% of care rejection might end if delirium were reversed. …