Developmental of definitions for acute illness in nursing home residents based on chart-recorded physical exam findings

Objectives: To develop and test simple, chart-based criteria for acute illness in nursing home residents for clinical and epidemiological study. Design: Observational study. Setting: A 409-bed not-for-profit nursing home. Participants: 102 custodial care residents. Measurements: Physical exam findings commonly performed in nursing home residents were used to define 10 acute conditions. Residents were observed prospectively to test the clinical relevance of these definitions. Episodes of acute illness satisfying definition criteria were identified, as well as treatment changes, hospitalizations, and deaths. Results: During a median follow-up of 60 days, 43 acute illnesses occurred, affecting 30 (29%) residents. Of these episodes, 77% were associated with treatment changes, hospitalization, or death. The new definitions captured 79% of all episodes of acute illness. The most common diagnoses were urinary tract infection, lower respiratory infection, and gastroenteritis/gastrointestinal upset. Independent risk factors for acute illness were gastrostomy feeding, depression, and history of fracture. Conclusions: Acute illness in the nursing home is common and frequently associated with treatment changes, hospitalization and death. It can be identified using a small number of chart-recorded physical exam-based findings as criteria.