Document Detail


Predictors of do not resuscitate orders in the nursing home.
MedLine Citation:
PMID:  15871866     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The outcome of cardiopulmonary resuscitation of residents of long-term care facilities is poor. However, only about one half of residents of long term care facilities have a do not resuscitate (DNR) order. The remainder usually have resuscitation by order or by default policy. Understanding predictors of DNR may help clinicians address end-of-life issues with the older long-term care population. OBJECTIVES: To determine (1) the prevalence of DNR orders, and (2) predictors of DNR orders in older institutionalized individuals in a large community teaching nursing home. METHODS: A cross-sectional chart review study of 177 consecutively located older patients from an 899-bed academic long-term care facility. RESULTS: The prevalence of a DNR order was 40%. The frequency of ordering DNR was greater in subjects who were 85 years or older compared with subjects who were younger than 85 years (57% vs. 30%, P < .05). Ordering DNR was associated significantly with race (49% of whites compared with 13% African Americans, P < .05) but not with sex. Subjects with a DNR order were more likely to have been diagnosed with depression (52% vs. 35%, P < .05) but not dementia, and overall had greater number of medical conditions (5.9 +/- 2 vs. 5.1 +/- 2, P < .05) compared with subjects without DNR orders. The frequency of DNR orders did not significantly differ between subjects who were able to ambulate (with or without assistance) compared with subjects who were wheelchair or bed bound. Using logistic regression analysis, only age (with a B of -1.04 and P of .017) and race (with a B of 1.4 and a P of .01) were independent predictors of DNR status. CONCLUSION: Fewer than half of this sample of long-term care residents had a DNR order. Among seven factors studied, only age and race were independent predictors of DNR status in the nursing home.
Authors:
Barbara J Messinger-Rapport; Hosam K Kamel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Medical Directors Association     Volume:  6     ISSN:  1525-8610     ISO Abbreviation:  J Am Med Dir Assoc     Publication Date:    2005 Jan-Feb
Date Detail:
Created Date:  2005-05-05     Completed Date:  2005-12-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100893243     Medline TA:  J Am Med Dir Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-21     Citation Subset:  IM    
Affiliation:
Section of Geriatric Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. Rapporb@ccf.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Forecasting
Homes for the Aged*
Humans
Male
New York
Nursing Homes*
Resuscitation Orders*
Statistics, Nonparametric

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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