Medical care in old age: what do nurses in long-term care consider appropriate?

Area of Science:

• Gerontology
• Bioethics
• Nursing Practice

Background:

• Older adults often have complex health conditions requiring nuanced treatment decisions.
• Advance care planning is crucial for respecting patient autonomy and preferences.

Purpose of the Study:

• To assess long-term care nurses' preferences for treatment limitations in older adults.
• To examine if care intensity preferences correlate with patient health status.

Main Methods:

• Nurses completed advance directives for various patient scenarios.
• Scenarios included terminal illness, dementia, chronic illness, and healthy older adults.
• Refusal rates of interventions were analyzed across scenarios.

Main Results:

• Overall, nurses favored limiting interventions (72.1% refusal rate).
• Refusal rates were highest for terminal illness (90.9%) and lowest for robust individuals (50.0%).
• Higher physical and cognitive impairment correlated with greater preference for treatment limitations.

Conclusions:

• Long-term care nurses demonstrate clear preferences for limiting interventions in older age.
• Treatment limitation preferences intensify with increased patient impairment.
• Advance planning discussions should encompass a wide spectrum of care appropriateness.