Implementing a "Do-Not-Resuscitate" (DNR) policy in a nursing home

Area of Science:

• Gerontology
• Bioethics
• Health Policy

Background:

• New Do-Not-Resuscitate (DNR) policies require careful evaluation.
• Understanding patient and surrogate decision-making is crucial for end-of-life care.

Purpose of the Study:

• To evaluate DNR and resuscitation (CODE) decisions in New York nursing home patients.
• To analyze factors influencing these decisions among patients with and without decision-making capacity.

Main Methods:

• A study evaluated 233 nursing home patients' DNR/CODE decisions under a new policy.
• Data collected included patient capacity, surrogate choices, and patient demographics.

Main Results:

• Patients with capacity chose DNR (n=18) or CODE (n=30).
• Surrogates made DNR (n=54) or CODE (n=131) decisions for patients lacking capacity.
• Patient age influenced surrogate DNR choices; quality of life and premorbid feelings guided patient choices.

Conclusions:

• Patient capacity, underlying conditions, and age significantly impact end-of-life decisions.
• Surrogate response rates and decision-making timelines present implementation challenges.
• Effective DNR policies require consideration of patient values and surrogate support.