To Screen or Not to Screen

In long-term care (LTC) facilities, patients may receive any number of health screenings. Some are routine primary or secondary preventive screenings, whereas others are prompted by an event, such as reported hallucinations or an outbreak of an infectious disease. Sometimes determining what to screen a resident for can be challenging, as many factors must be considered, including the benefits versus risks of the screening procedure, the cost of the procedure, the resident’s life expectancy and physical condition, and the resident’s capability of making his or her own informed decision. In this issue of Annals of Long-Term Care: Clinical Care and Aging (ALTC ), various screening-related topics are examined.

In our Ask the Expert article, “Prostate-Specific Antigen Prostate Cancer Screening: Answers to the Critical Questions", Dr. Austin discusses prostate cancer screening, focusing on the US Preventive Services Task Force (USPSTF) recent recommendation advising against screening men of any age group for prostate cancer using prostate-specific antigen (PSA) testing. According to the USPSTF, PSA testing has had nominal, if any, effect on reducing prostate cancer mortality and can result in multiple harms, including unnecessary patient anxiety and complications from prostate biopsies. The USPSTF’s recommendation has sparked considerable controversy, and many clinicians and organizations have spoken out against this decision, including the American Urological Association (AUA). In a press statement (bit.ly/AUS-PSAstmt), the AUA notes “It is inappropriate and
irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations, such as African American men. Men who are in good health and have more than a 10-15 year life expectancy should have the choice to be tested and not discouraged from doing so.” So what does all this mean for LTC residents? As Dr. Austin notes in his article, PSA screening probably should not be included as a routine health maintenance examination in the LTC setting, particularly if the resident is a frail elder, but residents also should not be prevented from undergoing PSA testing if this is something that they want to do. Furthermore, it is important to remember that younger persons also reside in LTC facilities. Therefore, LTC providers should treat each case individually and make every effort to help educate their patients about PSA testing, enabling them to make an informed decision. 

In another article, “Charles Bonnet Syndrome in a Nonagenarian”, Dr. Haider reports the case of a female patient who had hallucinations, but realized that they were not real. Although the visions did not overly distress the patient, she expressed fear that her mind was going. The patient underwent various screening examinations for these hallucinations, including a cognitive assessment and vision testing.  The cognitive assessment showed no impairment, but the vision screening showed her to be legally blind. Based on these findings, a diagnosis of Charles Bonnet syndrome was made. The patient was counseled on this condition, environmental factors were addressed, and the use of pharmacologic treatments was avoided. Although visual impairment is common among elders, particularly LTC residents, this population rarely receives vision screenings. Yet untreated vision problems can lead to behavioral issues, anxiety, increased risk of injury, and a reduced quality of life, regardless of the resident’s cognitive status. Therefore, there is a need to improve vision screenings for LTC residents.

In our Practical Research article, “Pharmacist-Led Model of Antibiotic Stewardship in a Long-Term Care Facility", the authors discuss an antibiotic stewardship program that they implemented in their nursing home. Through this program, the authors sought to reduce the incidence of inappropriate antibiotic prescribing, a practice that can lead to drug-related complications, increased bacterial resistance, and other problems. During the study, pharmacists examined data (eg, culture reports) for residents who were prescribed antibiotics to determine the appropriateness of antibiotic use in these individuals, and they intervened when they found it to be inappropriate. The authors report that inappropriate antibiotic prescribing was reduced by 50% in their nursing home as a result of this program. This report illustrates the benefits of interprofessional team care.  The appropriate use of antibiotics in LTC settings can be improved by the careful screening of patients and their laboratory test results. 

We hope you enjoy this issue of ALTC and we welcome your feedback on any of the articles. You can send your comments to our assistant editor, Allison Musante, at amusante@hmpcommunications.com.

Thank you for reading!