The frequency of "do-not-resuscitate" order in aged in-patients: effect of patient- and non-patient-related factors.
OBJECTIVE
The purpose of this study was to examine the effect of patient- and non-patient-related factors (co-morbidity, demographics, and method of surveillance) on the frequency of "do-not-resuscitate" (DNR) orders in aged inpatients.


METHODS
On a geriatric ward, during three different periods within 1 year, we used two different methods of data collection (with or without a form) and two different time-frames (prevalence or incidence) in studying the frequency of DNR orders, demographic data and the Pre-Arrest Morbidity (PAM) Index.


RESULTS
In a sample of 261 patients the DNR decision was related to patient-related factors, including the PAM score and age. Only 3 patients with a score above 4 had no DNR order and in the group of 142 patients > 83 years 85 (59.9%) had a DNR order, compared to 52 (43.7%) of the 119 patients of 83 years or less (p < 0.05). In contrast, gender and marital status were not related to the presence of a DNR order. The variables PAM score, age, form and time-frame classified 76.6% of the cardiopulmonary resuscitation (CPR) decisions correctly and 71.5% of the DNR decisions correctly. Without attention to the resuscitation decision, the written DNR order frequency decreased significantly from 64-59% to 23%. An explanation for this variance may be the passive process of data collection, a non-patient-related factor.


CONCLUSIONS
The DNR decision is related to the PAM index score and age. The variance in DNR decisions is partly related to the method of data collection, a non-patient-related factor in DNR decision-making. Without attention to the DNR/CPR decision, the DNR frequency decreased markedly.
Dautzenberg
P L
PL
Department of Geriatrics, Bosch Medicentrum's-Hertogenbosch, Netherlands.
Bezemer
P D
PD
Duursma
S A
SA
Schonwetter
R
R
Hooyer
C
C
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D015897:Comorbidity; D003625:Data Collection / Q000379:methods*; D003657:Decision Making; D016002:Discriminant Analysis; D005260:Female; D005853:Geriatrics; D006757:Hospital Units; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016414:Resuscitation Orders; D012720:Severity of Illness Index; D012959:Socioeconomic Factors