Ultrasound can help diagnose and manage many—if not most—of the diseases and conditions faced most frequently among nursing home residents. As a recent example, during the COVID-19 pandemic, ultrasound of the lungs and chest in nursing homes helped diagnose the risk, escalation, and long-term impact of the disease among some of the highest-risk populations.[1]
Populated mainly by aging residents with pre-existing health conditions, nursing homes and long-term care centers are uniquely positioned to offer quality treatment and support, detect new health issues earlier, and prevent escalation through consistent monitoring. With appropriate equipment, these facilities can also respond quickly and effectively to conditions common to older adults with convenient, in-house examinations.
Despite its demonstrated value in improving residents' health and quality of life, ultrasound utilization remains relatively low in nursing home environments; most residents must travel to a hospital or their primary care center. While multiple barriers prevent more widespread integration, the right system enables you to adapt and suit your diverse, nursing home needs.
Here's why increasing access to ultrasound in nursing homes is essential, and how practitioners can overcome obstacles to its implementation.
Why is increasing access to ultrasound in nursing homes essential?
Early detection of infection
The most common types of infection among nursing home residents affect the urinary tract, respiratory and digestive systems, and skin and soft tissue, with skin and soft-tissue infection (SSTI) being the third-highest cause of nursing home infections across the country.[2] This fast, cost-effective, and user-friendly means of diagnosis has shown efficacy in the detection and treatment of SSTIs; in some cases, it has been found more reliable than clinical exam alone.[3]
SSTIs such as abscesses, wound infections, and cellulitis, account for millions of emergency department visits each year. For older patients, like those who reside in nursing homes, emergency department (ED) visits present a unique set of challenges.[3] Early detection through ultrasound can help mitigate the need for ER visits and allow patients to seek preventative care from their general practitioner (GP) or a specialist.
An established and growing body of research indicates that ultrasound increases diagnostic accuracy in SSTIs and can influence treatment decisions.[3] Using ultrasound, healthcare providers can identify the presence of fluid collections, edema, or soft tissue stranding indicating inflammation. Scans can also help detect signs of a deeper infection, such as perifascial fluid and subcutaneous emphysema.[4] In one study, ultrasound utilization was a critical factor redirecting the course of treatment for patients initially thought to have cellulitis, demonstrating the possibility for more informed care.[5]
Assessing the scope and progression of MSK injuries
About half of all nursing home residents suffer at least one fall per year[6], and chronic pain and falls have long been associated with high rates of musculoskeletal (MSK) injury. Data from the World Health Organization (WHO) list fractures, osteoarthritis, and neck pain, all common afflictions among the elderly population, among the leading causes of MSK injury nationwide.[7]
Ultrasound has long been an effective tool in the detection and management of a wide array of MSK injuries, including, but not limited to:
- Tendonitis
- Bursitis
- Carpal tunnel syndrome
- Rotator cuff tears
- Joint problems
- Masses, tumors, and cysts
It's also been found to be an effective component of geriatric care and rehabilitation, specifically for conditions such as degenerative and rheumatic joint diseases, falls and trauma, peripheral nerve problems, sarcopenia, and others.[8]
Easy and direct access to MSK ultrasound at patients' bedsides can help ensure these injuries don't permanently affect mobility, cause long-term damage to muscles, ligaments, tendons, and bones, or threaten patients' safety. Providers can now access systems that allow them to easily transport the entire unit from room to room or facility to facility. Additionally, systems with image-optimization technology and custom probes allow clinicians to confidently examine shoulders, hands, knees, wrists, and other vulnerable MSK areas.
Heart disease treatment and management
Nursing home residents live with a variety of chronic conditions, including, most commonly, heart disease and chronic obstructive pulmonary disease (COPD). Ultrasound has been proven to be a valuable diagnostic resource in the onset and progression of coronary heart disease (CHD) and a wide range of other cardiac conditions.[9] Similarly, ultrasound of the lungs can help detect and prevent a wide array of pulmonary conditions.
The right system can help providers effectively analyze ejection fraction, valvular stenosis or insufficiency, hypertrophy, and other cardiac anomalies. Cardiac features that specifically optimize imaging of myocardial tissue with strain rate and tissue velocity aid in a confident diagnosis.
Urology diagnosis, assessment and treatment
Urinary incontinence and other urological issues affect a significant portion of nursing home residents across the country. Urologists who offer nursing home consultations report multiple, prevalent urologic problems in these patients: incontinence and dysfunctional voiding, use and management of indwelling catheters, asymptomatic bacteriuria, symptomatic urinary tract infection (UTI), hematuria, management of prostate, bladder and renal cancer, renal calculi, and more. Ultrasound can help assess the extent, origin, and ongoing risk of urological symptoms, guiding residents to faster, better-informed care and relief while preventing the escalation of serious diseases.
Management and treatment of podiatric diseases
Podiatry is a vital care pillar in nursing homes, skilled nursing facilities, and similar environments. Not only do patients commonly experience fractures, breaks, and sprains of the feet, but they also frequently present with diabetic ulcers and wounds that can suggest peripheral arterial disease, heart attacks, strokes, renal disease, and other serious conditions. Ultrasound has been an effective tool in helping to assess and care for a wide range of foot-and-ankle injuries, as well as diabetic wounds that create more urgent issues for aging patients.
More effectively integrate ultrasound into nursing homes and long-term care environments
While barriers, such as system size, training, and quality, have slowed the integration of ultrasound into nursing homes, newer options on the market were designed to be easier for less experienced users in environments with limited space. These systems, lightweight and portable enough to bring to patients' bedsides, offer intuitive, condition-specific functionalities that accommodate the wide range of conditions nursing home residents face, with precision, accuracy, and diagnostic confidence.
These systems can work for GPs and specialists looking to expand their services to nursing home consultation and assessments, as well as for long-term care facilities that wish to upgrade their current diagnostic infrastructure. They offer cutting-edge image optimization features, enhanced workflow tools, and comprehensive education and support services to accommodate clinicians at all experience levels.
Whether you're a clinician in a long-term care center who wants to expand and improve treatment options or a primary care physician looking to integrate nursing home populations into your practice, portable ultrasound is an effective tool in your arsenal.
Resources:
- Nouvenne A, Ticinesi A, Parise A, et al. Point-of-care chest ultrasonography as a diagnostic resource for COVID-19 outbreak in nursing homes. Journal of the American Medical Directors Association. 2020; 21(7): 919–923. https://doi.org/10.1016/j.jamda.2020.05.050
- Montoya A, & Mody L. Common infections in nursing homes: a review of current issues and challenges. Aging Health. 2011; 7(6): 889–899. https://doi.org/10.2217/ahe.11.80
- O'Rourke K. Ultrasound for the evaluation of skin and soft tissue infections. PubMed Central (PMC). June 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170135/
- Byrne T. For elder health, trips to the ER are often a tipping point. KFF Health News. https://kffhealthnews.org/news/for-elder-health-trips-to-the-er-are-often-a-tipping-point/#:~:text=Other%20research%20suggests%20that%20seniors,aftereffects%20of%20an%20ER%20visit. Accessed February 9, 2024.
- Tayal VS, Hasan N, Norton HJ, et al. The effect of soft‐tissue ultrasound on the management of cellulitis in the emergency department. Academic Emergency Medicine. 2006; 13(4): 384–388. https://doi.org/10.1197/j.aem.2005.11.074
- Schoberer D, Breimaier HE, Zuschnegg J, et al. Fall prevention in hospitals and nursing homes: Clinical practice guideline. Worldviews on Evidence-based Nursing. 2022; 19(2): 86–93. https://doi.org/10.1111/wvn.12571
- World Health Organization. Musculoskeletal health. Who.int. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions. Accessed February 9, 2024.
- Can B, Kara M, Kara Ö., et al. The value of musculoskeletal ultrasound in geriatric care and rehabilitation. International Journal of Rehabilitation Research. 2017; 40(4): 285–296. https://doi.org/10.1097/mrr.0000000000000239
- Zhang J, Du Y, Hu H, et al. Ultrasonographic assessment of cardiac function and disease severity in coronary heart disease. World Journal of Clinical Cases. 2021; 9(28): 8366–8373. https://doi.org/10.12998/wjcc.v9.i28.8366
