Do-not-resuscitate orders in an extended-care study group.

Area of Science:

• Gerontology
• Health Services Research
• Medical Ethics

Background:

• Do-Not-Resuscitate (DNR) orders are crucial for end-of-life care in nursing homes.
• Understanding the prevalence and decision-making process for DNR orders is essential for improving patient care.

Purpose of the Study:

• To determine the prevalence of written DNR orders among nursing home patients.
• To identify factors associated with the presence of DNR orders.
• To assess the documentation of patient or surrogate decision-maker participation in DNR decisions.

Main Methods:

• Retrospective chart review of 911 nursing home patients in Hennepin County, Minnesota.
• Data collection included demographic characteristics, DNR order status, surrogate decision-maker availability, and participation documentation.
• Statistical analyses included univariate and logistic regression models.

Main Results:

• Twenty-seven percent of patients had DNR orders.
• While 90% had available surrogate decision-makers, 31% of DNR orders lacked documentation of patient or surrogate involvement.
• Increased age, longer time since admission, skilled level of care, and surrogate presence were independently associated with DNR status.

Conclusions:

• Written DNR orders are prevalent in nursing homes, but decision-making documentation is often inadequate.
• Patient demographics, care level, and surrogate involvement are key factors associated with DNR status.
• Further research is needed to understand the physician decision-making process for DNR orders.