At Least Routine Laboratory Assessment…

To the Editor:—We have read with interest the paper by Carol Joseph and Yvonne Lyles on “Routine Laboratory Assessment of Nursing Home Patients”1 in which they recommend that the physician take a leadership role in helping nursing homes to develop clinically useful, cost-effective testing strategies. The authors also affirm that screening tests should not be performed unless the results will affect clinical action and lead to clinically significant benefit to the patients. However the real world of nursing homes is quite different from what we all think it should be. In nursing homes the technological level is very low, and often physicians work as they did 50 years ago. Nevertheless, diseases are frequent and will be even more frequent in the future when home care will allow the less severely diseased to remain at home. For example, in a longitudinal study (Progetto Longitudinale Gussago - Prologus) that we are now performing on patients admitted to a nursing home in Gussago (Brescia, Italy), the mean number of diseases is 8.9 ± 2.7 for each patient, and the mean number of drugs taken is 4.9 ± 1.7; every year 24% of patients die; the others suffer from a high incidence of acute events (4.1 ± 3.9 per year). In this perspective, is it really possible to care for an elderly patient without having at least a yearly series of routine laboratory tests performed? As physicians, our way of working is dependent on an exact biohumoral assessment of the patient in order not only to detect treatable diseases but also to find out potential comorbidity effects that are not apparent in the physical examination and to orient therapy. People living in nursing homes are ill; if we want to keep our role as physicians devoted to the global care of the elderly we need a minimum of objective data. Thus, we can avoid narrowing our role to that of social workers, who are doubtlessly relevant to the care of the elderly but who are not sufficient for preserving the health of the elderly in nursing home patients. Editors note:—The above letter was referred to the authors of the original paper and their reply follows.