Nursing home residents' preferences for life-sustaining treatments.
OBJECTIVE
To determine life-sustaining treatment preferences among nursing home residents, whether information regarding cardiopulmonary resuscitation (CPR) affected these preferences, and with whom treatment preferences had been discussed, and to identify factors associated with CPR preferences.


METHODS
In-person survey.


METHODS
Forty-nine randomly selected nursing homes.


METHODS
Four hundred twenty-one randomly selected nursing home residents capable of making decisions.


METHODS
Preferences regarding CPR, hospitalization, and enteral tube feedings, and individual factors associated with CPR preferences.


RESULTS
Of 1458 randomly selected nursing home residents assessed for the ability to participate in the study, 552 residents (38%) were eligible to participate and 421 agreed to be interviewed. Sixty percent of participants able to participate in the decision reported that they would elect CPR, 89% would choose hospitalization if seriously ill, and 33% would elect enteral tube feedings if no longer able to eat because of permanent brain damage. Individual factors associated with preferences for CPR included the following: African-American ethnicity, high self-reported physical mobility, belief that most important medical care decisions should be made by the doctor, moderate-to-severe impairment in daily decision-making skills, and not having a spouse. Fourteen percent changed their preference from preferring CPR to not preferring CPR after receiving additional information about CPR procedures. Twelve percent reported having discussed preferences with health care providers, and 31% discussed preferences with family members.


CONCLUSIONS
More than half of nursing home residents capable of making decisions preferred the use of CPR. Few had discussed their preferences with health care providers. Individual preferences should be assessed when considering the use of life-sustaining treatments.
D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases; D016887:Cardiopulmonary Resuscitation / Q000523:psychology; D032882:Comprehension; D003625:Data Collection; D003657:Decision Making; D030881:Disclosure; D004750:Enteral Nutrition; D005006:Ethnicity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008020:Life Support Care / Q000523:psychology; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D009735:Nursing Homes; D011897:Random Allocation; D018570:Risk Assessment; D028761:Withholding Treatment