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Related Experiment Videos

Code status decision-making in a nursing home population: processes and outcomes

F R Kellogg1, A Ramos

  • 1Dept of Community Medicine, St. Vincent's Hospital, New York, NY 10011.

Journal of the American Geriatrics Society
|February 1, 1995
PubMed
Summary

Nursing home residents can effectively make prehospital code status decisions, including do-not-resuscitate (DNR) orders. These decisions do not impact short-term care intensity but reduce hospital use in the final months of life.

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Area of Science:

  • Gerontology
  • Palliative Care
  • Health Services Research

Background:

  • Advance care planning is crucial for nursing home residents.
  • Code status discussions in nursing homes are complex and impact end-of-life care.
  • Understanding factors influencing these decisions is essential for quality care.

Purpose of the Study:

  • To evaluate the clinical utility of prehospital code status discussions in nursing homes.
  • To analyze health care outcomes associated with these decisions.
  • To identify patient and variable factors influencing code status choices.

Main Methods:

  • Retrospective observational study utilizing record review.
  • Involved 350 residents from a skilled-level teaching nursing home over two years.
Keywords:
Death and EuthanasiaEmpirical ApproachNew York CityVillage Nursing Home (New York City)

Related Experiment Videos

  • Examined decisions made by residents or their surrogates.

    • Main Results:

    • Code status decisions were made for 80% of residents, primarily do-not-resuscitate (DNR) orders by surrogates.
    • DNR decisions were associated with dementia, white race, and older age.
    • No significant short-term changes in care intensity or hospital use were observed post-DNR, but reduced hospital use occurred in the final six months of life.

    Conclusions:

    • Prehospital code status discussions are clinically effective in nursing home settings.
    • Do-not-resuscitate (DNR) orders do not affect short-term care intensity outside of medical intensive care.
    • DNR orders are associated with decreased hospital utilization in the final six months of life.