Tags

Type your tag names separated by a space and hit enter

Advance Directives and Care Received by Older Nursing Home Residents.
Am J Hosp Palliat Care. 2017 Mar; 34(2):105-110.AJ

Abstract

BACKGROUND

Research shows variable success as to whether care provided aligns with individual patient preferences as reflected in their advance directives (AD).

OBJECTIVE

We aimed to study AD status and subsequent care received in older nursing home (NH) residents deemed at risk for infections and care transitions: those with a urinary catheter (UC), feeding tube (FT), or both. Design/participants/measurements: A subgroup analysis of a prospective cohort of 90 residents with a UC and/or FT from 15 NHs in southeast Michigan. Outcomes assessed at enrollment and at 30-day intervals were hospitalizations and antibiotic use. The ADs were divided as follows: (1) comfort oriented: comfort measures only, no hospital transfer; (2) palliative oriented: comfort focused, allowing hospital transfer (except intensive care unit), antibiotic use, but no cardiopulmonary resuscitation; (3) usual care: full code, no limitations to care. We calculated incidences for these outcomes.

RESULTS

Seventy-eight (87%) residents had ADs: 18 (23%) comfort oriented, 32 (41%) palliative oriented, and 28 (36%) usual care. The groups did not differ regarding demographics, comorbidity, function, device presence, or time in study. Using the usual care group as comparison, the comfort-oriented group was hospitalized at a similar rate (Incidence rate [IR] = 15.6/1000 follow-up days vs IR = 8.8/1000 follow-up days, Incident rate ratio [IRR] 0.6 [95% confidence interval, CI, 0.3 -1.1], P value .09) but received fewer antibiotics (IR = 18.9/1000 follow-up days vs IR = 7.5/1000 follow-up days, IRR 0.4 [95% CI, 0.2-0.8], P value .005).

CONCLUSION

Nursing home residents with comfort-oriented ADs were hospitalized at a rate similar to those with usual-care ADs but received fewer antibiotics, although the small sample size of this analysis suggests these findings deserve further study.

Authors+Show Affiliations

1 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA.1 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA.1 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA.1 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26494830

Citation

Manu, Erika R., et al. "Advance Directives and Care Received By Older Nursing Home Residents." The American Journal of Hospice & Palliative Care, vol. 34, no. 2, 2017, pp. 105-110.
Manu ER, Mody L, McNamara SE, et al. Advance Directives and Care Received by Older Nursing Home Residents. Am J Hosp Palliat Care. 2017;34(2):105-110.
Manu, E. R., Mody, L., McNamara, S. E., & Vitale, C. A. (2017). Advance Directives and Care Received by Older Nursing Home Residents. The American Journal of Hospice & Palliative Care, 34(2), 105-110. https://doi.org/10.1177/1049909115611875
Manu ER, et al. Advance Directives and Care Received By Older Nursing Home Residents. Am J Hosp Palliat Care. 2017;34(2):105-110. PubMed PMID: 26494830.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance Directives and Care Received by Older Nursing Home Residents. AU - Manu,Erika R, AU - Mody,Lona, AU - McNamara,Sara E, AU - Vitale,Caroline A, Y1 - 2016/07/11/ PY - 2015/10/24/pubmed PY - 2017/7/15/medline PY - 2015/10/24/entrez KW - advance directives KW - care processes KW - feeding tube KW - nursing home KW - older adults KW - urinary catheter SP - 105 EP - 110 JF - The American journal of hospice & palliative care JO - Am J Hosp Palliat Care VL - 34 IS - 2 N2 - BACKGROUND: Research shows variable success as to whether care provided aligns with individual patient preferences as reflected in their advance directives (AD). OBJECTIVE: We aimed to study AD status and subsequent care received in older nursing home (NH) residents deemed at risk for infections and care transitions: those with a urinary catheter (UC), feeding tube (FT), or both. Design/participants/measurements: A subgroup analysis of a prospective cohort of 90 residents with a UC and/or FT from 15 NHs in southeast Michigan. Outcomes assessed at enrollment and at 30-day intervals were hospitalizations and antibiotic use. The ADs were divided as follows: (1) comfort oriented: comfort measures only, no hospital transfer; (2) palliative oriented: comfort focused, allowing hospital transfer (except intensive care unit), antibiotic use, but no cardiopulmonary resuscitation; (3) usual care: full code, no limitations to care. We calculated incidences for these outcomes. RESULTS: Seventy-eight (87%) residents had ADs: 18 (23%) comfort oriented, 32 (41%) palliative oriented, and 28 (36%) usual care. The groups did not differ regarding demographics, comorbidity, function, device presence, or time in study. Using the usual care group as comparison, the comfort-oriented group was hospitalized at a similar rate (Incidence rate [IR] = 15.6/1000 follow-up days vs IR = 8.8/1000 follow-up days, Incident rate ratio [IRR] 0.6 [95% confidence interval, CI, 0.3 -1.1], P value .09) but received fewer antibiotics (IR = 18.9/1000 follow-up days vs IR = 7.5/1000 follow-up days, IRR 0.4 [95% CI, 0.2-0.8], P value .005). CONCLUSION: Nursing home residents with comfort-oriented ADs were hospitalized at a rate similar to those with usual-care ADs but received fewer antibiotics, although the small sample size of this analysis suggests these findings deserve further study. SN - 1938-2715 UR - https://www.unboundmedicine.com/medline/citation/26494830/Advance_Directives_and_Care_Received_by_Older_Nursing_Home_Residents_ L2 - http://journals.sagepub.com/doi/full/10.1177/1049909115611875?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -