Effect of do-not-resuscitate orders on hospitalization of nursing home residents evaluated for lower respiratory infections.

• Abstract: OBJECTIVES: To determine resident and facility characteristics associated with do-not-resuscitate (DNR) orders and to test the effect of DNR orders on hospitalization of acutely ill nursing home (NH) residents with lower respiratory tract infections (LRIs). DESIGN: Prospective cohort. SETTING: Thirty-six NHs (almost 4,000 residents) in central and eastern Missouri in the Missouri Lower Respiratory Infection study. PARTICIPANTS: NH residents with a LRI (n=1031). MEASUREMENTS: Data were obtained from new Minimum Data Set evaluations, resident examination, and chart review. Associations between resident, physician, and facility characteristics and the presence of a DNR order and hospitalization within 30 days from evaluation for an LRI were analyzed. RESULTS: Sixty percent of subjects had a DNR order, and 2% had a do-not-hospitalize order. Resident characteristics associated with a DNR order included older age, white race, having a surrogate decision-maker, NH residence for longer than 3 years, and more-impaired cognition. Residents with DNR orders were more likely to live in facilities with more licensed beds, a lower proportion of Medicaid recipients, and a higher prevalence of influenza vaccination. After controlling for potential confounders, residents with a DNR order before the acute illness episode were significantly less likely to be hospitalized (adjusted odds ratio=0.69, 95% confidence interval=0.49-0.97). CONCLUSION: DNR orders independently reduce the risk of hospitalization for LRI and may function as a marker for undocumented care limitations or as a mandate to limit care (unrelated to resuscitation) in NH residents with LRI.
• Authors: Steven C Zweig, Robin L Kruse, Ellen F Binder, Kristina L Szafara, David R Mehr (Affiliation: Department of Family and Community Medicine, University of Missouri-Columbia School of Medicine, Columbia, Missouri 65212, USA. ZweigS at missouri.edu)
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 52 Issue 1 Pg. 51-8 (Jan 2004) ISSN: 0002-8614 [Print] United States
• PMID: 14687315 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Female
• Hospitalization
• Humans
• Logistic Models
• Male
• Missouri (epidemiology)
• Nursing Homes
• Prospective Studies
• Respiratory Tract Infections (mortality)
• Resuscitation Orders