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A comprehensive health care directive in a home for the aged
1Department of Medicine, McMaster University, Hamilton.
Objectives:
To examine the use of and compliance with a new comprehensive health care directive by residents of a home for the aged and to determine the effect of the directive on the use of health care services.
Design:
Descriptive study with a before-after design.
Setting:
A home for the aged providing residential care to women.
Participants:
All 119 residents (ages 71 to 103 years, mean age 87.5 years).
Intervention:
Introduction of a comprehensive health care directive and follow-up at 1 year.
Outcome Measures:
Residents' treatment choices, compliance with the directive, number of hospital admissions and length of hospital stay, number of deaths and places where deaths occurred.
Results:
Ninety (76%) of the residents completed the directive. In the event of reversible life-threatening illness 34, 24, 11 and 21 residents requested supportive, limited, maximum and intensive care respectively. For irreversible illness the numbers were 75, 12, 3 and 0 respectively. In case of cardiac arrest 88% requested that cardiopulmonary resuscitation not be done. In the year before the introduction of the directive there were nine deaths, one in the home and eight in hospitals. In the year after there were 17 deaths, 11 in the home and 6 in hospitals. The mean length of hospital stay was significantly lower in that year than in the year before implementation (p less than 0.001).
Conclusions:
This innovative health care directive seems to be feasible, practical and well supported by residents, their families and health care professionals. Further studies are required to establish the generalizability and reproducibility of the data to other elderly people in institutions, to chronically ill patients and to the community at large.