Do-not-resuscitate orders in an extended-care study group.
We examined the charts of 911 nursing home patients in Hennepin County, Minnesota, to determine the prevalence of written do-not-resuscitate (DNR) orders. Information regarding demographic characteristics, and whether a surrogate decisionmaker was available and participated in the decision, was also collected. Twenty-seven percent of patients had DNR orders. Ninety percent of all patients had potentially available surrogate decisionmakers. However, for 31% of patients with DNR orders, there was no documentation of patient or surrogate participation in the DNR decision. Univariate analysis identified female sex; increased age, level of care (skilled versus intermediate), presence of a potential surrogate decisionmaker, and increasing length of time since nursing home admission as factors associated with presence of DNR orders. When a logistic regression model was used, increased age, increased length of time since nursing home admission, skilled versus intermediate level of care, and presence of a surrogate decisionmaker were independently associated with presence of DNR status. Several variables are independently associated with written DNR orders; their relationship to the factors physicians use in decision making requires further study.
Evans Memorial Department of Clinical Research, Boston University School of Medicine, Massachusetts.
R M
RM
Meyers
N
N
Lurie
R B
RB
Breitenbucher
C J
CJ
Waring
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D004282:Documentation; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D009732:Nursing Care / Q000145:classification; D010343:Patient Admission; D010358:Patient Participation; D016414:Resuscitation Orders; D012737:Sex Factors; D012866:Skilled Nursing Facilities; D028761:Withholding Treatment