Prevalence of advance directives and do-not-resuscitate orders in community nursing facilities
M. Terry and S. Zweig
Washington University School of Medicine, St Louis, MO.
OBJECTIVE: To determine the prevalence of advance directives and
do-not-resuscitate (DNR) orders in nursing homes and to measure the effect
of the Patient Self-Determination Act (PSDA) and patient characteristics on
these prevalences. DESIGN: Cross-sectional study. SETTING: Eight rural
community nursing facilities. PARTICIPANTS: Six hundred forty-one records
of nursing home residents (total census of eight facilities). RESULTS: The
mean age of the residents was 82.6 years and 75% were women. Thirty-seven
percent were judged to have decisional capacity. Less than one third of the
records revealed an advance directive (standard living will, 11.5%; other
written directive, 11.1%; durable power of attorney for health care, 12%).
Thirty-six percent had DNR orders. Residents with advance directives were
older than those without them. Those residents with advance directives were
more likely to have been admitted to the nursing home after the enactment
of the PSDA (25.1% before vs 37.9% after enactment; P < .0001). There
was substantial variation among facilities in both prevalences. Written
rationales for DNR orders were found in only 40% of records. CONCLUSION:
Enactment of the PSDA reflects increased interest in documentation of
advance directives. However, in many nursing facilities, the prevalence of
advance directives and DNR orders is relatively low. A greater commitment
will be required by providers, residents, and their proxies if we are to
change this reality.
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ABSTRACT
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Cohen-Mansfield et al.
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Cherniack
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ABSTRACT
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Hammes and Rooney
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