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The article discusses the nursing home admissions and role of physicians in the rehabilitation, medical care and end-of-life care of older patients in the U.S. Among the factors that led to delay in nursing home admission based on studies were comprehensive geriatric assessment and home visits to determine modifiable risk factors. The importance of recognizing risk factors for admission to planning for the future care needs of older adults is noted. Physicians are encouraged to advise prospective residents and their families to speak to staff and residents at nursing homes. It recommends the American Medical Directors Association (AMDA) as a resource for the continuing education of physicians in nursing home care.

OBJECTIVES: To estimate the percentage of U.S. women aged 70 and older who reported a recent mammography recommendation and to identify whether factors suggesting limited life expectancy, such as comorbidities, are associated with a lower probability of a reported recommendation. DESIGN: A national, population-based, cross-sectional survey. SETTING: United States. PARTICIPANTS: There were 1,782 screen-eligible women 70 and older who responded to the National Health Interview Survey in 2005 and met eligibility criteria, including reporting at least one doctor visit in the previous 12 months. Weighted, these women represented almost 9.3 million women nationally. MEASUREMENTS: Multiple logistic regression was used to examine the relationship between demographic, comorbidity, and health services utilization variables on self-reported physician recommendation for a mammogram. RESULTS: More than half (58.9%) of the sample reported a recent mammography recommendation (63.0% of those aged 70 to 79 and 51.5% of those aged 80 and older). The strongest multivariable association suggested that women who reported a recent clinical breast examination (CBE) had 5.9 times greater odds of reporting a mammography recommendation than women who reported never having a CBE. CONCLUSION: This study failed to find negative associations between factors suggesting limited life expectancy and a recent mammography recommendation. Instead, findings revealed a strong positive association between a recent CBE and mammography recommendation. Findings may suggest that recent clinical interactions weigh more heavily on a decision to recommend mammography to older, screen-eligible women than considerations for the woman's overall long-term health or may reflect a greater perceived or actual recall of physician recommendations from women with a recent CBE. [ABSTRACT FROM AUTHOR]

At the University of Missouri-Columbia School of Medicine, we developed a voluntary senior-mentor program, the Senior Teacher Educator Partnership (STEP), for first- and second-year medical students. Using qualitative research methods, we examined the impact of STEP on medical students' attitudes and then assessed the congruence of what is learned through STEP with the knowledge, skills, and attitudes needed to provide care to the elderly patient. STEP was found to be a successful strategy for teaching themes of recognizing the elderly within an ecological context, enhancing sympathy and empathy, emphasizing respect for elderly persons, and gaining an appreciation that aging is an individualized process. New areas identified for student learning experiences included understanding the complexity of the health care system and its impact on elderly patients, understanding the payment system, and developing skills in assessment and care coordination. A model is described for continuous enhancement of educational programs to be used to improve educational experience in geriatrics. doi:10.1300/J021v27n02_05 [ABSTRACT FROM PUBLISHER]

Identifies patient characteristics predictive of 30-day mortality in nursing home residents with a lower respiratory tract infection (LRI). Design, setting, and patients in the study made in Missouri; Main outcome measures; Results; Conclusion that the research distinguishes those at relatively low risk for mortality due to LRI.