From the June Issue of JAMDA

Abstract

More than one-third of nursing home patients with suspected breast cancer were not referred for further testing, according to results of a Web-based survey of elder-care physicians in the Netherlands. “Health care in the Netherlands is organized in such a way that, basically, all referrals to [cancer] clinics and hospital are initiated by the primary care physician …. As the highest concentration of elderly patients is found in nursing homes, we decided to start there,” said Dr. Marije E. Hamaker of the department of geriatric medicine at Diakonessenhuis Hospital in Utrecht, the Netherlands. The researchers sent a survey to all 1,239 elder care physicians in the country. Of the 419 (34%) who responded, almost 60% said they encountered at least one patient with suspected breast cancer in the past year, but many said they didn't refer some of them for further testing in a clinic or hospital. End-stage dementia, cited by 57% of respondents, was the primary reason for not referring patients. Other reasons included preferences of the patient or family (29%), limited life expectancy (23%), poor functional status (18%), somatic comorbidity (16%), and advanced age (8%). Also, 13% said that hospital visits, the diagnostic process, and treatments would be too great a burden for the patients. Among the patients referred to hospitals, 5% had a benign tumor, 16% received no treatment, 24% received hormone treatment, and 8% received radiotherapy. Only one patient received chemotherapy. In 18% of patients, the diagnostic process was ongoing at the time of the survey. “I think the most important outcome of this study is that nonreferral of older patients actually happens quite frequently, at least in the Netherlands,” Dr. Hamaker said. She added that the reasons physicians cited for not referring patients with suspected breast cancer are valid. “However, we do think that uncontrolled breast cancer can have serious impact on quality of life, particularly in very frail patients …. As about 80% of elderly breast cancer patients have tumors that are responsive to hormone treatment, this might be a useful alternative.” An even better solution, she said, is to find ways to offer hospital-level care in nursing homes, to cause minimal disruption for the patients. ▸ Source: Nonreferral of Nursing Home Patients with Suspected Breast Cancer – Hamaker et al. Little information is available about physician involvement in preventing falls among people in long-term care, Kirsten A. Nyrop, Ph.D., of the University of North Carolina at Chapel Hill and her colleagues posited, so they mailed surveys to 131 physicians about working with nursing home staff to reduce fall risks for individual patients. The 31 physicians who responded said they conducted fall assessments for 47% of residents and worked with staff to prevent falls in 36% of residents. The percentages intending to conduct assessments and work with staff to prevent falls were 75% and 62%, respectively. The views and behaviors of attending physicians in LTC facilities play a significant role in risk assessment, monitoring, and management of fall risk, the researchers said. ▸ Source: Fall Prevention and Monitoring of Assisted Living Patients: An Exploratory Study of Physician Perspectives – Nyrop et al.