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Stability of preferences regarding life-sustaining treatment: a two-year prospective study of nursing home residents.
Mt Sinai J Med 2003; 70(2):85-92MS

Abstract

BACKGROUND

The use of advance directives is based on the consensus that physicians should respect preferences expressed by competent patients about future treatments. Patient preferences are, however, subject to change and may be influenced by a number of factors. The purpose of our study was to evaluate the durability over time of decisions made regarding terminal care of mentally intact nursing home patients and the influence of such factors as intervening illness, loss of significant others, and cognitive, emotional and functional decline.

METHODS

We undertook a longitudinal prospective cohort study in which 65 mentally competent nursing home patients were interviewed at three intervals (at baseline and after one and two years). For each patient, demographic, medical and socioeconomic data were collected and assessment of mood, function, cognition and preference for life-sustaining therapies (including cardiopulmonary resuscitation and parenteral and enteral nutrition) was obtained.

RESULTS

Preferences regarding cardiopulmonary resuscitation and parenteral and enteral nutrition changed over both the 12- and 24-month study periods. Only degree of change in cognitive status proved to be predictive of changes in decision. Gender, presence or absence of depression, change in level of functional abilities and intercurrent illness or stressor did not influence change regarding life-sustaining therapy.

CONCLUSIONS

In light of our findings, we suggest that periodic re-evaluation of these advance directives be performed and that ongoing discussions be initiated with their patients by health care professionals.

Authors+Show Affiliations

Mount Sinai School of Medicine, New York, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12634900

Citation

McParland, Elaine, et al. "Stability of Preferences Regarding Life-sustaining Treatment: a Two-year Prospective Study of Nursing Home Residents." The Mount Sinai Journal of Medicine, New York, vol. 70, no. 2, 2003, pp. 85-92.
McParland E, Likourezos A, Chichin E, et al. Stability of preferences regarding life-sustaining treatment: a two-year prospective study of nursing home residents. Mt Sinai J Med. 2003;70(2):85-92.
McParland, E., Likourezos, A., Chichin, E., Castor, T., & Paris BE, B. E. (2003). Stability of preferences regarding life-sustaining treatment: a two-year prospective study of nursing home residents. The Mount Sinai Journal of Medicine, New York, 70(2), pp. 85-92.
McParland E, et al. Stability of Preferences Regarding Life-sustaining Treatment: a Two-year Prospective Study of Nursing Home Residents. Mt Sinai J Med. 2003;70(2):85-92. PubMed PMID: 12634900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stability of preferences regarding life-sustaining treatment: a two-year prospective study of nursing home residents. AU - McParland,Elaine, AU - Likourezos,Antonios, AU - Chichin,Eileen, AU - Castor,Tita, AU - Paris BE,Barbara E, PY - 2003/3/14/pubmed PY - 2003/6/18/medline PY - 2003/3/14/entrez SP - 85 EP - 92 JF - The Mount Sinai journal of medicine, New York JO - Mt. Sinai J. Med. VL - 70 IS - 2 N2 - BACKGROUND: The use of advance directives is based on the consensus that physicians should respect preferences expressed by competent patients about future treatments. Patient preferences are, however, subject to change and may be influenced by a number of factors. The purpose of our study was to evaluate the durability over time of decisions made regarding terminal care of mentally intact nursing home patients and the influence of such factors as intervening illness, loss of significant others, and cognitive, emotional and functional decline. METHODS: We undertook a longitudinal prospective cohort study in which 65 mentally competent nursing home patients were interviewed at three intervals (at baseline and after one and two years). For each patient, demographic, medical and socioeconomic data were collected and assessment of mood, function, cognition and preference for life-sustaining therapies (including cardiopulmonary resuscitation and parenteral and enteral nutrition) was obtained. RESULTS: Preferences regarding cardiopulmonary resuscitation and parenteral and enteral nutrition changed over both the 12- and 24-month study periods. Only degree of change in cognitive status proved to be predictive of changes in decision. Gender, presence or absence of depression, change in level of functional abilities and intercurrent illness or stressor did not influence change regarding life-sustaining therapy. CONCLUSIONS: In light of our findings, we suggest that periodic re-evaluation of these advance directives be performed and that ongoing discussions be initiated with their patients by health care professionals. SN - 0027-2507 UR - https://www.unboundmedicine.com/medline/citation/12634900/Stability_of_preferences_regarding_life_sustaining_treatment:_a_two_year_prospective_study_of_nursing_home_residents_ L2 - https://medlineplus.gov/nursinghomes.html DB - PRIME DP - Unbound Medicine ER -