Medical Care in the Nursing Home, 2nd Edition
Ouslander, JG, Osterweil, D, Morley, J
McGraw-Hill 1997
Reviewed by: Barry J. Goldlist, MD, FRCPC, FACP
This text was clearly meant to appeal to the American nursing home physician. However, it has much value to offer the Canadian physician involved in long term care. This text is applicable to what we would consider separate fields: residential care, nursing home care, and chronic hospital care (complex continuing care), as most American nursing homes can have several levels of nursing care.
Part one of the text covers general and administrative aspects of medical care in the nursing home, and is based on American legislation and requirements. Nevertheless, the sections on environment, pre-admission assessment, screening and health maintenance, and interdisciplinary teams are fully applicable to the Canadian scene. The description of the minimum data set (MDS) is also useful, as it is making substantial inroads in Canadian long term care. The section on total quality management in the nursing home will be particularly useful to medical directors.
Part two of the book is called clinical conditions, and is extremely strong. There is no attempt to create a comprehensive text of medical problems in the nursing home, rather the issues that differ from other areas of medical practice are stressed. The chapters on falls and urinary incontinence will be particularly helpful to Canadian physicians involved in long term care. The section on depression tends to favor tricyclic antidepressants over SSRI's in the treatment of the depressed nursing home patient. This is probably counter to the usual Canadian practice, but the authors are in fact correct in stating that there is little scientific evidence to favor the much costlier SSRI's.
Section three, General Management issues is extremely relevant to the Canadian long term care sector. Issues such as drug use, rehabilitation, ethics, and education are well presented from the viewpoint of the nursing home. The section on pain management and palliative (hospice) care is particularly useful, as this is frequently a neglected area in long term care.
The final section is a real bonus. There are numerous examples of policies and procedures, and various forms that are useful in the nursing home setting. In fact, throughout the text, whenever an assessment tool is recommended, it is included in its entirety in the book so that adoption of the tool in the nursing home requires little extra effort.
In summary, this is a book that is intended for the American nursing home physician. Nevertheless, most of the book is also applicable to the Canadian physician involved in long term care, and I would recommend it highly to them.
