Implementing a "Do-Not-Resuscitate" (DNR) policy in a nursing home.
During implementation of a new Do-Not-Resuscitate (DNR) policy in New York State, decisions by 233 nursing home patients of their surrogates were evaluated. Eighteen patients with capacity (mean age +/- SD = 76.4 +/- 12.1 years) chose DNR; 30 patients with capacity (mean age +/- SD = 76.2 +/- 10.7 years) chose to be resuscitated (CODE); 54 patients without capacity, (mean age +/- SD = 86.1 +/- 9.1 years) had surrogates who chose DNR; and 131 patients without capacity and with surrogates (mean age +/- SD = 81.9 +/- 9.8 years) remained CODE. Most patients with capacity who chose DNR had multiple sclerosis, while most choosing CODE had strokes. Most patients who lacked capacity had dementia. Forty-five percent of surrogates did not respond regarding CODE status during the three-month study interval, and 10% wanted additional time to decide. Patient age appeared to be a factor in surrogate choice for DNR but not in patients with capacity making their own decision. Reasons for patients with capacity choosing DNR are discussed; perceived quality of life and premorbid feelings by patients help in the decision-making process.
Fader
A M
AM
New York Medical College, New York.
Gambert
S R
SR
Nash
M
M
Gupta
K L
KL
Escher
J
J
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005065:Euthanasia; D005066:Euthanasia, Passive; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007258:Informed Consent; D007883:Legislation, Medical; D008297:Male; D008875:Middle Aged; D009518:New York; D009735:Nursing Homes; D018579:Patient Selection; D011788:Quality of Life; D012151:Resuscitation