Faculty Bibliography

OBJECTIVES/OBJECTIVE:Internal medicine residents often provide hospital care for patients who are admitted from and discharged to nursing homes. This pilot study surveyed internal medicine residents for their assumptions and perceptions about demographics and regulations in the nursing home setting. DESIGN/SETTING/PARTICIPANTS/METHODS:Internal medicine residents at Winthrop University Hospital in Long Island, New York, were asked to participate in this anonymous, voluntary, and self-administered written survey during October 2006. MEASUREMENTS/METHODS:Survey answers were collected and analyzed using SAS 9.1 (SAS Institute, Inc., Cary, NC). RESULTS:The mean responses were very close to the actual data; however, the range and standard deviations (SD) of responses revealed a wide variation in perceptions about nursing home demographics and regulations. For example, the internal medicine residents estimated that 60% of nursing home beds are for long-term care but the responses ranged from 20% to 90%, with an SD of 21. Awareness about regulations such as payment sources and the role of the medical director was poor. Fifty-two percent of respondents stated that Medicare is the primary source of payment for long-term care. Eighty-five percent of the respondents believed that the medical director of a nursing home could be a physician, nurse, social worker, or nursing home administrator. CONCLUSION/CONCLUSIONS:Although internal medicine residents have high exposure to nursing home patients, many of those surveyed have incorrect perceptions about nursing home demographics and requirements. Further research is required to demonstrate the impact of formal geriatric medicine education on internal medicine residents' knowledge regarding nursing home demographics and regulations.

OBJECTIVE:To identify nursing home standards related to resident smoking through a nation wide survey of directors of nursing. METHODS:A national survey was distributed online and was completed by 248 directors of nursing. The directors of nurses answered questions concerning resident smoking including the criteria utilized to determine an unsafe resident smoker. For those residents identified as unsafe, the questions asked were specifically related to monitoring, staff involvement, safety precautions and policy. RESULTS:The results of the survey demonstrated a consistent policy practiced among facilities across the United States. The monitoring of nursing home residents is based on a resident's mental acuity, physical restrictions and equipment requirements. Once a resident was identified as a smoker at risk of harm to self or others, staff involvement ranged from distributing cigarettes to direct supervision. In addition, the majority of facilities required residents to wear fire resistant aprons and provided a fire extinguisher in smoking areas. CONCLUSION/CONCLUSIONS:Monitoring policies of nursing home residents who smoke starts with identifying those residents at risk based on an assessment of mental acuity, physical restrictions and equipment requirements. Those that are identified as being at risk smokers have their cigarettes controlled and distributed by nursing staff and are supervised by facility staff when smoking. This policy is implemented through written policy as well as staff education. Despite some discrepancies in the actual implementation of policies to supervise residents who smoke, the policies for assessment for at-risk smokers requiring monitoring is consistent on a national basis.

OBJECTIVE:To compare diurnal body temperature between young and old subjects. DESIGN/METHODS:Analysis of oral temperatures obtained from 167 elderly subjects residing in the nursing home and 21 high school students. SETTING/METHODS:Two nursing homes and a high school. PARTICIPANTS/METHODS:Participants were 167 nursing home subjects and 21 high school students. MEASUREMENTS/METHODS:Oral temperatures were measured in the morning and afternoon among nursing home subjects and high school students using an electronic digital thermometer. RESULTS:The average age of old and young subjects was 82.5 and 14.6 years, respectively. Mean morning temperature was not different between the old (97.3 +/- 0.82 degrees F) and young (97.1 +/- 1.03 degrees F). In young subjects, afternoon temperatures increased by 0.69 +/- 1.15 degrees F to 97.8 +/- 0.92 degrees F (P < .05) while temperatures in old subjects rose by 0.14 +/- 1.11 degrees F to 97.4 +/- 0.93 degrees F (P > .05). The increase during the day was greater for young subjects compared with the old (P < .04). Two of 20 young and 8 of 167 old subjects had temperatures of 98.6 degrees F or greater in the morning while 3 of 20 young and 21 of 163 old subjects achieved this temperature or higher in the afternoon. CONCLUSION/CONCLUSIONS:Both older and young subjects have mean oral body temperatures lower than 98.6 degrees F. Relatively few young and old subjects even achieve this temperature. The diurnal rise in body temperature was less among nursing home subjects compared with younger subjects.