title: Origination of medical advance directives among nursing home residents with and without serious mental illness.
abstract: OBJECTIVE
  Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans.
  
  
  METHODS
  Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with (N=1,769) and without (N=11,738) serious mental illness. Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; do-not-resuscitate and do-not-hospitalize orders; and orders concerning restriction of feeding tube, medication, or other treatments.
  
  
  RESULTS
  The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66-.87, p<.001). Similar results were found for individual documented plans.
  
  
  CONCLUSIONS
  Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding.
authors.affiliation: Division of General Internal Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Dr., C44-N GH, Iowa City, IA 52242, USA. yue-li@uiowa.edu
authors.forename: Xueya
authors.initials: X
authors.lastname: Cai
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes; D011618:Psychotic Disorders; D016414:Resuscitation Orders; D012559:Schizophrenia; D014481:United States