title: Elders' environs and their end-of-life preferences.
abstract: OBJECTIVE
  Elders' predilections regarding end-of-life interventions vary with their living environs.
  
  
  METHODS
  Patients in 3 settings--assisted living/outpatient, skilled nursing facility (SNF), and acute hospitalization--were asked to complete a brief questionnaire.
  
  
  RESULTS
  A total of 269 patients who averaged 80.0 ± (SD) 8.1 years, 44% male, 70% white were studied. Eighty-five patients were outpatient elderly, 101 were hospitalized for acute illnesses, and 83 were interviewed in SNFs. Outpatients (44/85; 52%) and acutely ill inpatients (40/101; 40%) were more likely than patients residing in SNFs (19/81; 23%) to choose comfort care only (P = .047) for acute pneumonia requiring endotracheal intubation (ETI). Overall, 32% changed their choice for ETI, opting for comfort care only if acute pneumonia was followed by disposition to an SNF. However, ambulatory and acutely ill elderly patients were 3 times as likely as SNF patients to change from aggressive to comfort care if the most likely outcome was disposition to an SNF (P < .001). In multivariate regression models, age (>80), gender, number of lost ADLs (>2), and self-described quality of life were not associated with choosing comfort care instead of ETI, whereas place of residence (SNF versus home) was independently associated with choosing ETI (odds ratio = 3.5; 95%CI = 1.9-6.4). Similarly, those already living in an SNF were more likely to opt for remaining there for advancing dementia (odds ratio = 7.7; 95%CI = 3.8-15.8). However, choices for ETI did not coincide with choosing an SNF for advancing dementia.
  
  
  CONCLUSIONS
  Elders residing in nursing homes were more likely than ambulatory patients to request invasive end-of-life care, a difference that was more pronounced when outcome required disposition to an SNF. These preferences were not dependent on patients' self-described disability or quality of life. This study suggests that qualitative outcomes matter to patients and their choices are associated with their place of residence.
authors.affiliation: Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT 06610, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gheorghe
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Vazquez
authors.forename: Ana I
authors.initials: AI
authors.lastname: Casanegra
authors.forename: Vivian
authors.initials: V
authors.lastname: Argento
authors.forename: Ramona
authors.initials: R
authors.lastname: Dadu
authors.forename: Yan
authors.initials: Y
authors.lastname: Feng
authors.forename: Yaw
authors.initials: Y
authors.lastname: Amoateng-Adjepong
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Manthous
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D005260:Female; D019538:Health Care Surveys; D006761:Hospitals; D006801:Humans; D008297:Male; D057240:Patient Preference; D012866:Skilled Nursing Facilities; D013727:Terminal Care / Q000379:methods*