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OBJECTIVE: In Italian nursing homes (NHs), care delivery at night and during holidays is not regulated by regional laws; some facilities employ staff physicians, others employ physicians engaged from year to year (temporary physicians), and others employ publicly funded National Health System (NHS) physicians. This study was designed to determine whether the use of different kinds of physicians leads to different outcomes with regard to the rate of hospitalization and appropriateness of the management of adverse clinical events. DESIGN: Prospective, nonrandomized-survey data collection. SETTING: Ten nonprofit nursing facilities in Italy. PARTICIPANTS: Three hundred and fifty-two NH residents, staff physicians, temporary physicians, and NHS physicians. MEASUREMENTS: Medical intervention during adverse clinical events occurring at night and during holidays. RESULTS: Three hundred and fifty-two residents experienced 551 adverse clinical events; 78 were hospitalized. The hospitalization rate of NHS physicians was about two times that of the temporary physicians and six times that of the staff physicians. Staff physicians' diagnoses and management were appropriate in the majority of cases; NHS diagnosis and management were doubtful or incorrect in about one-third of all cases. CONCLUSIONS: NH residents frequently experience adverse clinical events; physician characteristics influence the rate of hospitalization and the quality of medical interventions.

The aim of the study was to identify the prevalence of depressive symptoms (GDS score) and predictors of mood changes over a 12-month period in 56 nursing home residents (13 males and 43 females; mean age 81.1 ± 8.6). At baseline, 48.2% of the residents who scores above 11 on the MMSE had a GDS score > 15. GDS score was associated with pain, disabling diseases and self-evaluation of health, and independently with dissatisfaction with the nursing home environment, low level of nursing home social activities and younger age. Five depressed residents became non-depressed, eight non-depressed became depressed and 14 residents remained persistently depressed 12 months after baseline. After controlling for potential confounders, increasing GDS score was independently associated with decreasing basic activities of daily living, increasing number of clinical problems and younger age. Our data support the hypothesis that specific emotional adjustments can be found even in the apparently static environment of the nursing home.