Cluster deaths in long-term care institutions: an investigation of excess deaths in two Ontario institutions.

OBJECTIVE: To review clusters of deaths in two Ontario long-term care institutions and to establish whether common etiologic factors could be identified. METHOD: Retrospective review of the health care records of all residents who died to assess the events leading to death and the actions of the institutions and local coroners in response to the deaths. RESULTS: A respiratory infectious outbreak appeared to lead to many of the deaths in both institutions. Several deficiencies were identified with respect to charting practices, coroners' case investigations and institutional responses to the infectious outbreaks. No formal mechanisms were in place to assist in the early detection of cluster deaths in these institutions. CONCLUSIONS: Infectious outbreaks may be an important cause of cluster deaths in long-term care institutions. Standards should be developed for patient charting, coroners' investigations and for the prevention, identification and management of infectious outbreaks in such settings.

New Frontiers in Geriatric Education: Integrated hospital and community rotation.

The author describes a 1-month rotation in geriatric medicine for family practice residents. Residents work at a geriatric center with day patients, residents in a home for the aged, and acute and chronic-care hospital patients, under the supervision of geriatricians, family physicians, and specialists. They then work in the office of a family physician or in an outpatient miniclinic within a senior citizen housing complex. All residents reported increased comfort with elderly patients, and many have chosen to include geriatrics in their practices.