Do-Not-Resuscitate and Do-Not-Hospitalize Orders in Nursing Homes: Who Gets Them and Do They Make a Difference?

Tanuseputro, Peter; Hsu, Amy T; Chalifoux, Mathieu; Talarico, Robert; Kobewka, Daniel; Scott, Mary; Kyeremanteng, Kwadwo; Perri, Giulia

doi:10.1016/j.jamda.2019.02.017

Cited by 18 publications

(20 citation statements)

References 40 publications

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“…48 Several sociodemographic factors were associated with anticoagulant use. Residents who were currently married, a form a social support associated with more aggressive end-of-life care, 49 had slightly higher odds of anticoagulant use. Variation in anticoagulant use was observed between individuals of different races or ethnicities and between counties with varying racial or ethnic composition.…”

Section: Discussionmentioning

confidence: 95%

Geographic Variation in Anticoagulant Use and Resident, Nursing Home, and County Characteristics Associated With Treatment Among US Nursing Home Residents

Alcusky

Baek

Tjia

et al. 2021

Journal of the American Medical Directors Association

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Section: Discussionmentioning

confidence: 95%

Geographic Variation in Anticoagulant Use and Resident, Nursing Home, and County Characteristics Associated With Treatment Among US Nursing Home Residents

Alcusky

Baek

Tjia

et al. 2021

Journal of the American Medical Directors Association

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“…Respondents also estimated that only 29.4% of the ADs contained information on end-of-life hospital transfers. Literature from the United States and Canada suggests that around 4-23% of the nursing home residents have do-not-hospitalize orders [42][43][44][45]. However, the American and the Canadian health care systems can hardly be compared to the German one.…”

Section: Findings and Comparison With The Literaturementioning

confidence: 99%

Nursing home staff’s perspective on end-of-life care of German nursing home residents: a cross-sectional survey

et al. 2020

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Background Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. Methods A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. Results 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. Conclusions Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.

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“…First, we did not have information pertaining to residents' goals of care, which could have influenced the likelihood of hospitalization [50]. Also, we did not have information on whether the hospitalizations were clinically appropriate, which may have affected hospitalization rates, especially if some hospitalizations were avoidable or medically unnecessary [50]. Moreover, resident language was obtained from in-home assessments using RAI-MDS 2.0, a validated questionnaire for frail, elderly residents.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents

et al. 2020

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Background Hospitalizations carry considerable risks for frail, elderly patients; this is especially true for patients with dementia, who are more likely to experience delirium, falls, functional decline, iatrogenic complications, and infections when compared to their peers without dementia. Since up to two thirds of patients in long-term care (LTC) facilities have dementia, there is interest in identifying factors associated with transitions from LTC facilities to hospitals. The purpose of this study was to investigate the association between dementia status and incidence of hospitalization among residents in LTC facilities in Ontario, Canada, and to determine whether this association is modified by linguistic factors. Methods We used linked administrative databases to establish a prevalent cohort of 81,188 residents in 628 LTC facilities from April 1st 2014 to March 31, 2017. Diagnoses of dementia were identified with a previously validated algorithm; all other patient characteristics were obtained from in-person assessments. Residents’ primary language was coded as English or French; facility language (English or French) was determined using language designation status according to the French Language Services Act. We identified all hospitalizations within 3 months of the first assessment performed after April 1st 2014. We performed multivariate logistic regression analyses to determine the impact of dementia and resident language on the incidence of hospitalization; we also considered interactions between dementia and both resident language and resident-facility language discordance. Results The odds of hospitalization were 39% lower for residents with dementia compared to residents without dementia (OR 0.61, 95% CI 0.57–0.65). Francophones had lower odds of hospitalization than Anglophones, but this difference was not statistically significant (OR 0.91, 95% CI 0.81–1.03). However, Francophones without dementia were significantly less likely to be hospitalized compared to Anglophones without dementia (OR 0.71, 95% CI 0.53–0.94). Resident-facility language discordance did not significantly affect hospitalizations. Conclusions Residents in LTC facilities were generally less likely to be hospitalized if they had dementia, or if their primary language was French and they did not have dementia. These findings could be explained by differences in end-of-life care goals; however, they could also be the result of poor patient-provider communication.

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Do-Not-Resuscitate and Do-Not-Hospitalize Orders in Nursing Homes: Who Gets Them and Do They Make a Difference?

Cited by 18 publications

References 40 publications

Geographic Variation in Anticoagulant Use and Resident, Nursing Home, and County Characteristics Associated With Treatment Among US Nursing Home Residents

Geographic Variation in Anticoagulant Use and Resident, Nursing Home, and County Characteristics Associated With Treatment Among US Nursing Home Residents

Nursing home staff’s perspective on end-of-life care of German nursing home residents: a cross-sectional survey

The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents

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