Purpose
To determine prevalence and correlates of decisions made about specific life-sustaining
treatments (LSTs) among residents in long-term care (LTC) settings, including characteristics
associated with having an LST performed when the resident reportedly did not desire
the LST.
Design and Participants
After-death interviews with 1 family caregiver and 1 staff caregiver for each of 327
LTC residents who died in the facility.
Setting
The setting included 27 nursing homes (NHs) and 85 residential care/assisted living
(RC/AL) settings in 4 states.
Measurements
Decedent demographics, facility characteristics, prevalence of decisions made about
specific LSTs, percentage of time LSTs were performed when reportedly not desired,
and characteristics associated with that.
Results
Most family caregivers reported making a decision with a physician about resuscitation
(89.1%), inserting a feeding tube (82.1%), administering antibiotics (64.3%), and
hospital transfer (83.7%). Reported care was inconsistent with decisions made in 5
of 7 (71.4%) resuscitations, 1 of 7 feeding tube insertions (14.3%), 15 of 78 antibiotics
courses (19.2%), and 26 of 87 hospital transfers (29.9%). Decedents who received antibiotics
contrary to their wishes were older (mean age 92 versus 85, P=.014). More than half (53.8%) of decedents who had care discordant with their wishes
about hospitalization lived in a NH compared with 32.8% of those whose decisions were
concordant (P=.034).
Conclusion
Most respondents reported decision making with a doctor about life-sustaining treatments,
but those decisions were not consistently heeded. Being older and living in a NH were
risk factors for decisions not being heeded.
Keywords
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Article info
Footnotes
This work was supported by grants R01 AG18967, K02 AG00970, and K23 AG001030 from the National Institute on Aging. H.B. was supported by a National Research Service Award Primary Care Research grant (T32 HP-14001–19) from the Health Resources and Services Administration as well as the Duke University Geriatrics Fellowship program. The authors have no other relevant financial disclosures to report.
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© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
