Most Older Long-Term Care Residents in Oslo Have Documented Do-Not-Resuscitate Status: A Cross-Sectional Study

With population aging, understanding the frequency and distribution of decisions to attempt or withhold cardiopulmonary resuscitation (CPR) in long-term care populations is increasingly important. In Oslo, CPR status, that is, an advance decision about whether CPR should or should not be attempted, is systematically assessed and documented for all long-term care residents. Comprehensive register data therefore provide a unique opportunity to assess advance CPR decisions at the population level. We obtained cross-sectional data on the documented CPR status of nearly all persons aged 50+ years admitted to public or private long-term care facilities in Oslo between 2018 and 2023 (N=7,860). We examined the proportion of long-term care residents with documented positive CPR status (CPR should be attempted) and used multivariable logistic regression to analyze the associations between documented positive CPR status and age, sex, marital status, primary contact (e.g., son, daughter, spouse, professional), functional limitations, institutional relocations, duration of stay, and year of admission. We found that 9.2% of long-term care residents had documented positive CPR status. Documented positive CPR status was related to younger age, fewer limitations, shorter duration of stay, and fewer relocations. Compared with residents first admitted in 2018, documented positive CPR status was less likely among those first admitted between 2019 and 2022, but not among those first admitted in 2023. There was no evidence that documented positive CPR status was related to sex, marital status, primary contact. Our findings provide population-level evidence on documented CPR status in long-term care and highlight the need for future research on how such decisions are made.