ANN ARBOR—The health of U.S. nursing home patients has improved slightly during the 1990s, according to a federally financed study published in the current (August) issue of the Journal of the American Geriatrics Society.

But for more elderly patients than ever, pain is a daily companion.

The study, headed by University of Michigan researcher Brant E. Fries, analyzes the prevalence and progress of eight relatively common health conditions at two points in time: in 1990 before a federally mandated system for assessing the condition and improving the treatment of nursing home residents was implemented, and again in 1993, after the National Resident Assessment Instrument (RAI) was being used in virtually all U.S. nursing homes, along with related treatment protocols.

The conditions examined in the study were dehydration, falls, decubitus (bed sores), vision problems, stasis ulcer (leg ulcers resulting from circulation problems), poor teeth and malnutrition.

For the study, Fries, a research scientist at the U-M Institute of Gerontology and a professor at the U-M School of Public Health, and colleagues analyzed 1990 data from a sample of 2,128 residents of 268 nursing homes in 10 states, then obtained 1993 data from 2,088 patients in 254 of the same homes.

Among the major findings:

• The prevalence of dehydration and stasis ulcer declined significantly from 1990 to 1993. While almost 5 percent of residents had ulcers in 1990, only 3 percent had the condition in 1993. For dehydration, the prevalence dropped from 2 percent to 1 percent.
• “Although these differences seem small, they apply to virtually all residents in U.S. nursing homes,” notes Fries, “so that a 50 percent decline in dehydration prevalence means that there are 18,000 additional nursing home residents in the United States without this condition and a system without the cost of their care.”
• In contrast, the prevalence of daily pain rose from about 13 percent in 1990 to 17 percent in 1993.
• In the areas of vision and nutrition, fewer residents declined during a six-month period after the RAI was implemented, compared with a six-month period before implementation. 

“Of the four conditions for which there are significant declines in prevalence or outcome changes—dehydration, stasis ulcer, vision and nutrition—care planning guidelines exist for all but stasis ulcer, and there is a resident assessment protocol (RAP) for treating a similar condition, decubitus ulcer,” says Fries.

“Pain, the only other condition with a significant result—an increase in prevalence—also has no RAP. This suggests that the improvements were specific to the Resident Assessment Instrument.”

The research was supported by the Health Standards and Quality Bureau of the Health Care Financing Administration.

Co-authors of the article were Catherine Hawes, Research Triangle Institute, North Carolina; John N. Morris, Hebrew Rehabilitation Center for the Aged, Boston, Massachusetts; Charles Phillips, Menorah Park Center for the Aging, Beachwood, Ohio; Vince Mor, Brown University, Providence, Rhode Island; and Pil S. Park, U-M Institute of Gerontology, Ann Arbor, Michigan.

More information: 

• Brant E. Fries
• Condition Study