title: End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home.
abstract: Education about end-of-life care and treatment options, communication between family and health care providers, and having advance directives and medical orders in place are important for older adults with chronic, progressive decline and end-stage disease who spend their last days in the nursing home. This study used retrospective data (6 months before death) of long-stay nursing home decedents (N = 300) taken from electronic health records to capture the end-of-life experience. Findings showed for almost all decedents, Do Not Resuscitate and Do Not Intubate orders were in place, and just over one-half had Do Not Hospitalize and No Artificial Feeding orders in place. A small proportion had No Artificial Hydration or No Antibiotic orders in place. Overall, there was congruence between documented medical orders and treatment received. Findings showed that use of hospice and discussions about particular life-sustaining treatments each had significant associations with having less aggressive medical orders in place. These results can inform best practice development to promote high quality, person-directed, end-of-life care for nursing home residents.
authors.affiliation: a Research Institute on Aging , The New Jewish Home , New York , New York , USA.
authors.forename: Joann P
authors.initials: JP
authors.lastname: Reinhardt
authors.affiliation: b Isabella Geriatric Center , New York , New York , USA.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Downes
authors.affiliation: a Research Institute on Aging , The New Jewish Home , New York , New York , USA.
authors.forename: Verena
authors.initials: V
authors.lastname: Cimarolli
authors.affiliation: c Excellus BlueCross BlueShield & MedAmerica Insurance Company , Rochester , New York , USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Bomba
mesh_terms: D032722:Advance Care Planning; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D006738:Hospices; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care / Q000523:psychology*
keywords: Health care; hospice; long-term care; palliative care