Resuscitation decisions on a Dutch geriatric ward

Area of Science:

• Geriatric Medicine
• Medical Ethics
• Health Policy

Background:

• Do Not Resuscitate (DNR) orders are crucial in geriatric care, but their application can be complex.
• Factors influencing DNR decisions require thorough investigation to ensure ethical and effective patient management.

Purpose of the Study:

• To analyze the utilization of DNR orders in a Dutch geriatric ward.
• To identify key factors influencing DNR decisions, including patient characteristics and healthcare team dynamics.
• To assess patient and family involvement in the DNR decision-making process.

Main Methods:

• Retrospective analysis of 148 admissions over a 4-month period on a Dutch geriatric ward.
• Statistical analysis, including regression, to determine factors influencing DNR order issuance.
• Comparison of DNR order decisions made by geriatric residents with assessments from other healthcare team members.

Main Results:

• 58% of admissions received a written DNR order.
• Age (>83 years) and pre-arrest morbidity (PAM) index significantly influenced DNR orders, with PAM > 4 almost always resulting in a DNR order.
• Patient or family involvement in DNR decisions was low (3% and 24% respectively). Healthcare team members disagreed with residents' decisions in 17-20% of cases, citing reasons like age, depression, and poor prognosis.

Conclusions:

• Physicians utilize factors beyond comorbidity when making DNR decisions.
• Low patient and family involvement highlights a need for improved communication and shared decision-making.
• Further research into non-comorbidity factors is essential for developing standardized DNR policies in geriatric care.