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The utilization of fecal occult blood testing in the institutionalized elderly
S E Klos1, P Drinka, J S Goodwin
1University of Minnesota, School of Public Health, Minneapolis.
Objective:
To examine physician use of stool guaiac testing in order to determine indications for testing, how the test was used, and the consequences of a particular test result.
Design:
Retrospective case series.
Setting:
Large midwestern inpatient nursing home facility.
Patients:
All patients with positive fecal occult blood tests (FOBT) and one-third of patients with negative FOBT.
Results:
In an 18-month period, 916 occult blood tests were performed on 339 patients (37% of the nursing home census). Patients over age 90 were as likely to receive FOBT as those under age 70. Fourteen percent of those tested had at least one positive test. Fifty-eight percent of the patients with positive tests underwent no additional diagnostic testing. No cause for the positive FOBT was found for 68% of patients receiving the test for routine screening. Physician estimates of how frequently they employed FOBT for these patients correlated very poorly with their actual practices (r = .17).
Conclusion:
There is a high prevalence of positive results from FOBT among nursing home patients. In most cases, such results do not cause a change of therapy or result in additional workup. Lack of information on the role of FOBT in nursing home patients contributes to the great diversity in utilization of this test by nursing home physicians.