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Nursing Home Residents Need Physicians' Services
- Richard W. Besdine, MD;
- Laurence Z. Rubenstein, MD; and
- Christine Cassel, MD
- University of Connecticut Health Center, Farmington, CT 06030. University of California, Los Angeles, Los Angeles, CA 90024. University of Chicago, Chicago, IL 60637. Requests for Reprints: Linda Johnson White, Director, Scientific Policy, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572.
“I am an 84-year-old woman. I have severe arthritis, and about 5 years ago, I broke my hip. As I look around this room, I see the pathetic ones (maybe the lucky ones) who have lost their minds, and the poor souls who should be out but nobody comes to get them, and the sick ones who are in pain. A doctor comes to see me once a month. He spends 3 to 5 seconds with me and then a few more minutes writing in the chart or joking with the nurses (My own doctor doesn't come to convalescent hospitals, so I had to take this one). I pray every night that I may die in my sleep and get this nightmare over with …” [1].
After reading such a “testimonial,” we are relieved that neither we nor anyone we care about lives in a nursing home. Alternatively, if a friend or relative resides in a nursing home, we hope that “hers is different.” But more and more Americans can expect to be admitted to a nursing home.
Why should independent, middle-aged adults worry about what goes on in nursing homes? Only 5% of Americans older than 65 years live in nursing homes, and only 10% are admitted in 1 year [2]. Some go home, some die, and some remain; that's not so bad. But a more detailed analysis is less comforting. Of persons who were 65 years of age in 1990, 43% will enter a nursing home in their lifetimes; 55% of these will stay at least 1 year, and 21% will stay 5 years or longer [3]. The remarkable yet continuing increases in life expectancy, even among the very old [4], strongly suggest that nursing home use will increase because use is strongly associated …
