Anna T. Monias, MD, Erickson Retirement Communities, Oak Crest Village, Parkville, MD.

Kenneth S. Boockvar, MD, MS, Assistant Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine; Investigator, Program of Research on Serious Physical and Mental Illness, Bronx Veterans Affairs Medical Center, Geriatric Research, Education, and Clinical Center, New York, NY.

Acute illness often presents atypically in long-term care patients. Atypical presentation refers to the lack of one or more symptoms or signs that usually indicate acute illness. Due to underlying medical illness, nursing home patients with acute infection, metabolic disorders, and even surgical emergencies frequently present with delirium, malaise, or weakness. Nursing assistants are often the first to recognize these non-specific indicators. It is imperative that researchers include assessments by nursing assistants when developing and validating tools to recognize early but atypical indicators of disease.

Key words: long-term care facility, atypical presentation, delirium, nursing assistants, non-specific symptoms.