Causes of Death in Elderly Nursing Home Residents

Goldberg, Todd H.; Botero, Andres

doi:10.1016/j.jamda.2008.04.011

Cited by 40 publications

(23 citation statements)

References 8 publications

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“…Only a few studies have approached the relationship, specifically noting increased post-operative mortality in patients with pre-operative DNR orders 23 and a high prevalence of DNR orders in patients who expired in the nursing home setting. 6 However, in our secondary analysis DNR status was not associated with death in the hospital. Further, DNR orders were not associated with higher initial triage severity indexes, demonstrating that patients who presented with DNR orders were not considered more or less acute upon arrival to the ED and were not more likely to expire during admission than those without orders.…”

Section: Resultscontrasting

confidence: 52%

152: Epidemiology of Advance Directives in Extended Care Facility Patients Presenting to the Emergency Department

Wall¹,

Hiest²

2009

Annals of Emergency Medicine

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Introduction:We conducted an epidemiologic evaluation of advance directives and do-notresuscitate (DNR) prevalence among residents of extended care facilities (ECF) presenting to the emergency department (ED). Methods:We performed a retrospective medical record review on ED patients originating from an ECF. Data were collected on age, sex, race, triage acuity, ED disposition, DNR status, power-of attorney (POA) status, and living will (LW) status. We generated descriptive statistics, and used logistic regression to evaluate predictors of DNR status.Results: A total of 754 patients over 20 months met inclusion criteria; 533 (70.7%) were white, 351 (46.6%) were male, and the median age was 66 years . DNR orders were found in 124 (16.4%, 95% CI [13.9-19.1%]) patients. In univariate analysis, there was a significant difference in DNR by gender (10.5% female vs. 6.0% male with DNR, p=0.013), race (13.4% white vs. 3.1% nonwhite with DNR, p=0.005), and age (4.0% <65 years; 2.9% 65-74 years, p=0.101; 3.3% 75-84 years, p=0.001; 6.2% >84 years, p<0.001). Using multivariate logistic regression, we found that factors associated with DNR status were gender (OR 1.477, p=0.358, note interaction term), POA status (OR 6.612, p<0.001), LW (18.032, p<0.001), age (65)(66)(67)(68)(69)(70)(71)(72)(73)(74) p=0.478;(75)(76)(77)(78)(79)(80)(81)(82)(83)(84) p=0.091, >84 years OR 5.258, P<0.001), with interactions between POA and gender (OR 0.294, P=0.016) and between POA and LW (OR 0.227, p<0.005). Secondary analysis demonstrated that DNR orders were not significantly associated with death during admission (p=0.084). Conclusion:Age, gender, POA, and LW use are predictors of ECF patient DNR use. Further, DNR presence is not a predictor of death in the hospital. [West J Emerg Med. 2015;16(7):966-973.]

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Section: Resultscontrasting

confidence: 52%

152: Epidemiology of Advance Directives in Extended Care Facility Patients Presenting to the Emergency Department

Wall¹,

Hiest²

2009

Annals of Emergency Medicine

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“…In nursing home-based samples, these conditions are also common causes, but about one-third of death certificates list the dementia itself (in a US study [8]), or cachexia/dehydration (in a Dutch study [9]). The difference may be due to recording practices in different settings.…”

Section: Death With Dementiamentioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

224

177

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Abstract. Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

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“…Recent trends in LTC populations include older age at admission, shorter duration of stay prior to death there and higher acuity supportive care needs (Wilson & Truman, ; Froggatt et al ., ). Most persons who are admitted to LTC facilities will reside there until they die (Goldberg & Botero, ). Thirty five per cent of deaths in LTC facilities in the United Kingdom (Siddell & Komaromy, ) and 44% of deaths in American nursing homes (Jones et al ., ) occurred within 1 year of admission.…”

Section: Introductionmentioning

confidence: 99%