Predictors of do not resuscitate orders in the nursing home.
Predictors of do not resuscitate orders in the nursing home.
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DOI：
10.1016/j.jamda.2004.12.006
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发表时间：
2005-01-01
影响因子：
7.6
通讯作者：
Kamel, Hosam K
中科院分区：
文献类型：
--
作者：
Messinger-Rapport, Barbara J;Kamel, Hosam K
背景：长期护理机构居民的心肺复苏结果较差。然而，只有大约一半的长期护理设施的居民有一个不复苏（DNR）命令。其余的通常通过命令或默认策略进行复苏。了解DNR的预测因子可能有助于临床医生解决老年长期护理population. Accuratives的生命末期问题：为了确定（1）DNR订单的患病率，和（2）在大型社区教学养老院的老年机构化个体中DNR订单的预测因子。一项横断面图表回顾性研究，177名连续位于899张床位的学术长期护理机构的老年患者。结果：DNR顺序的患病率为40%。85岁或以上受试者的DNR排序频率高于85岁以下受试者（57% vs. 30%，P <0.05）。选择DNR与种族显著相关（49%的白人与13%的非洲裔美国人，P <0.05），但与性别无关。与没有DNR命令的受试者相比，有DNR命令的受试者更有可能被诊断为抑郁症（52%对35%，P <0.05），但不是痴呆症，总体上有更多的医疗条件（5.9 +/- 2对5.1 +/- 2，P <0.05）。与坐轮椅或卧床的受试者相比，能够走动（有或没有帮助）的受试者的DNR订单频率没有显著差异。使用logistic回归分析，只有年龄（B为-1.04和0.017的P）和种族（B为1.4和0.01的P）是DNR状态的独立预测因素。结论：不到一半的长期护理居民的样本有DNR顺序。在研究的七个因素中，只有年龄和种族是养老院DNR状态的独立预测因素。
BACKGROUND: The outcome of cardiopulmonary resuscitation of residents of long-term care facilities is poor. However, only about one half of residents of long term care facilities have a do not resuscitate (DNR) order. The remainder usually have resuscitation by order or by default policy. Understanding predictors of DNR may help clinicians address end-of-life issues with the older long-term care population.OBJECTIVES: To determine (1) the prevalence of DNR orders, and (2) predictors of DNR orders in older institutionalized individuals in a large community teaching nursing home.METHODS: A cross-sectional chart review study of 177 consecutively located older patients from an 899-bed academic long-term care facility.RESULTS: The prevalence of a DNR order was 40%. The frequency of ordering DNR was greater in subjects who were 85 years or older compared with subjects who were younger than 85 years (57% vs. 30%, P < .05). Ordering DNR was associated significantly with race (49% of whites compared with 13% African Americans, P < .05) but not with sex. Subjects with a DNR order were more likely to have been diagnosed with depression (52% vs. 35%, P < .05) but not dementia, and overall had greater number of medical conditions (5.9 +/- 2 vs. 5.1 +/- 2, P < .05) compared with subjects without DNR orders. The frequency of DNR orders did not significantly differ between subjects who were able to ambulate (with or without assistance) compared with subjects who were wheelchair or bed bound. Using logistic regression analysis, only age (with a B of -1.04 and P of .017) and race (with a B of 1.4 and a P of .01) were independent predictors of DNR status.CONCLUSION: Fewer than half of this sample of long-term care residents had a DNR order. Among seven factors studied, only age and race were independent predictors of DNR status in the nursing home.