Prevalence of Advance Directives and Do-Not-Resuscitate Orders in Community Nursing Facilities
Martha Terry;
Steven Zweig, MD, MSPH
Arch Fam Med. 1994;3(2):141-145.
Abstract
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.
Author Affiliations
From the Washington University School of Medicine, St Louis, Mo (Ms Terry), and the Health of the Public Program and the Department of Family and Community Medicine, University of Missouri—Columbia (Dr Zweig).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Use of Advance Directives for Nursing Home Residents in the Emergency Department
Weinick et al.
AM J HOSP PALLIAT CARE 2008;25:179-183.
ABSTRACT
Differences in Presenting Advance Directives in the Chart, in the Minimum Data Set, and Through the Staffs Perceptions
Cohen-Mansfield et al.
The Gerontologist 2003;43:302-308.
ABSTRACT
| FULL TEXT
Increasing use of DNR orders in the elderly worldwide: whose choice is it?
Cherniack
J. Med. Ethics 2002;28:303-307.
ABSTRACT
| FULL TEXT
Implementation of Advance Directives Among Community-Dwelling Veterans
Molloy et al.
The Gerontologist 2000;40:213-217.
ABSTRACT
| FULL TEXT
Systematic Implementation of an Advance Directive Program in Nursing Homes: A Randomized Controlled Trial
Molloy et al.
JAMA 2000;283:1437-1444.
ABSTRACT
| FULL TEXT
Public Information and Private Search: Evaluating the Patient Self-Determination Act
Bradley and Rizzo
Journal of Health Politics, Policy and Law 1999;24:239-273.
ABSTRACT
The Patient Self-Determination Act and Advance Directive Completion in Nursing Homes
Bradley et al.
Arch Fam Med 1998;7:417-423.
ABSTRACT
| FULL TEXT
Death and End-of-Life Planning in One Midwestern Community
Hammes and Rooney
Arch Intern Med 1998;158:383-390.
ABSTRACT
| FULL TEXT
Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders in the Nursing Home
Zweig
Arch Fam Med 1997;6:424-429.
ABSTRACT
PREVALENCE OF ADVANCE DIRECTIVES REMAINS LOW IN NURSING HOMES
JWatch General 1994;1994:6-6.
FULL TEXT
|
