title: Advance directives at end-of-life: nursing home resident preferences for artificial nutrition.
abstract: OBJECTIVE
  Nursing homes are increasingly the place where many Americans die. Thus, advance directives are critical to the preservation of the autonomous wishes at end-of-life. The purpose of this paper is to determine if preferences for artificial nutrition, as stated in the advance directives of nursing home residents, are honored in the last 2 months of life.
  
  
  METHODS
  Secondary analysis.
  
  
  METHODS
  Six Maryland community nursing homes.
  
  
  METHODS
  Fifty-seven consented residents (age 62 to 98) from the parent study who died during the study period.
  
  
  METHODS
  Retrospective document review including advance directives and clinical care provided in the last 2 months of life.
  
  
  RESULTS
  Most of the nursing home residents in this sample refused feeding tubes, and these preferences were honored during the last 2 months of life (93%), despite some (17% to 26%) with documented weight loss. A small percentage (8.8%) of residents received feeding tubes at end-of-life and, of those, only 1 was consistent with advance directive preferences. Most advance directives in this study included feeding tube preferences.
  
  
  CONCLUSIONS
  In this nursing home sample, advance directives were significant documents guiding decisions on artificial nutrition, and feeding tubes were in fact uncommon at the end of life. The study suggests that advance care planning, quality palliative care training, and administrative support are necessary for the honoring of preferences. Future research is needed to examine more broadly tube-feeding practices and prevalence in nursing homes.
authors.affiliation: West Chester University College of Health Sciences, Department of Nursing, West Chester, PA 19383, USA. cmonturo@wcupa.edu
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Monturo
authors.forename: Neville E
authors.initials: NE
authors.lastname: Strumpf
mesh_terms: D024362:Advance Directive Adherence; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009735:Nursing Homes; D010166:Palliative Care; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012737:Sex Factors; D015431:Weight Loss