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Advance directives and mortality rates among nursing home residents in Taiwan: A retrospective, longitudinal study.
Int J Nurs Stud. 2017 Mar; 68:9-15.IJ

Abstract

BACKGROUND

No data-based evidence is available regarding the best time for nursing home nurses to obtain residents' signatures on advance directives, especially for do-not-resuscitate directives, the most common type of advance directive. This information is needed to enhance the low prevalence of advance directives in Asian countries.

OBJECTIVES

The purposes of this study were to understand (1) the timing between nursing home admission and signing a do-not-resuscitate directive, (2) the factors related to having a do-not-resuscitate directive, and (3) the association between having a do-not-resuscitate directive and nursing home residents' mortality in Taiwan.

DESIGN

Retrospective, longitudinal design.

SETTING

Six nursing homes in Taiwan.

PARTICIPANTS

Nursing home residents (N=563).

METHODS

Data were collected by retrospective chart review with 1-year follow-up. Factors related to having a do-not-resuscitate directive were analyzed by multiple logistic regression, while associations between signing a do-not-resuscitate directive (resuscitation preference) and mortality were examined by Cox proportional hazard regression models.

RESULTS

The mean interval between nursing home admission and signing a do-not-resuscitate directive was 840.65days (2.30 years), which was longer than the time from admission to first transfer to hospital (742.4days). Having a do-not-resuscitate directive was related to whether the resident had a nasogastric tube (odds=2.57) and the number of transfers to hospital (odds=1.18). Among the 563 residents, 55 (9.77%) had died at the 1-year follow-up. Having a do-not-resuscitate directive was associated with a greater risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.10-3.98; p=0.02), but this risk did not persist after adjusting for age (hazard ratio, 1.89; 95% confidence interval, 0.99-3.59; p=0.05).

CONCLUSION

Early research recommendations to sign an advance directive, particularly a do-not-resuscitate order, on nursing home admission may not be the best time for Chinese nursing home residents. Our results suggest that the best time to sign a do-not-resuscitate directive is as early as possible and no later than 2 years (742days) after admission if residents had not already done so. Residents on nasogastric tube feeding should be particularly targeted for discussions about do-not-resuscitate directives.

Authors+Show Affiliations

School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan. Electronic address: yftsai@mail.cgu.edu.tw.Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; Department of Medicine, Chang Gung University, Tao-Yuan, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28033524

Citation

Tsai, Hsiu-Hsin, et al. "Advance Directives and Mortality Rates Among Nursing Home Residents in Taiwan: a Retrospective, Longitudinal Study." International Journal of Nursing Studies, vol. 68, 2017, pp. 9-15.
Tsai HH, Tsai YF, Liu CY. Advance directives and mortality rates among nursing home residents in Taiwan: A retrospective, longitudinal study. Int J Nurs Stud. 2017;68:9-15.
Tsai, H. H., Tsai, Y. F., & Liu, C. Y. (2017). Advance directives and mortality rates among nursing home residents in Taiwan: A retrospective, longitudinal study. International Journal of Nursing Studies, 68, 9-15. https://doi.org/10.1016/j.ijnurstu.2016.12.006
Tsai HH, Tsai YF, Liu CY. Advance Directives and Mortality Rates Among Nursing Home Residents in Taiwan: a Retrospective, Longitudinal Study. Int J Nurs Stud. 2017;68:9-15. PubMed PMID: 28033524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance directives and mortality rates among nursing home residents in Taiwan: A retrospective, longitudinal study. AU - Tsai,Hsiu-Hsin, AU - Tsai,Yun-Fang, AU - Liu,Chia-Yih, Y1 - 2016/12/15/ PY - 2016/04/08/received PY - 2016/12/10/revised PY - 2016/12/13/accepted PY - 2016/12/30/pubmed PY - 2017/12/30/medline PY - 2016/12/30/entrez KW - Advance directives KW - Do-not-resuscitate directive KW - Mortality KW - Nursing home SP - 9 EP - 15 JF - International journal of nursing studies JO - Int J Nurs Stud VL - 68 N2 - BACKGROUND: No data-based evidence is available regarding the best time for nursing home nurses to obtain residents' signatures on advance directives, especially for do-not-resuscitate directives, the most common type of advance directive. This information is needed to enhance the low prevalence of advance directives in Asian countries. OBJECTIVES: The purposes of this study were to understand (1) the timing between nursing home admission and signing a do-not-resuscitate directive, (2) the factors related to having a do-not-resuscitate directive, and (3) the association between having a do-not-resuscitate directive and nursing home residents' mortality in Taiwan. DESIGN: Retrospective, longitudinal design. SETTING: Six nursing homes in Taiwan. PARTICIPANTS: Nursing home residents (N=563). METHODS: Data were collected by retrospective chart review with 1-year follow-up. Factors related to having a do-not-resuscitate directive were analyzed by multiple logistic regression, while associations between signing a do-not-resuscitate directive (resuscitation preference) and mortality were examined by Cox proportional hazard regression models. RESULTS: The mean interval between nursing home admission and signing a do-not-resuscitate directive was 840.65days (2.30 years), which was longer than the time from admission to first transfer to hospital (742.4days). Having a do-not-resuscitate directive was related to whether the resident had a nasogastric tube (odds=2.57) and the number of transfers to hospital (odds=1.18). Among the 563 residents, 55 (9.77%) had died at the 1-year follow-up. Having a do-not-resuscitate directive was associated with a greater risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.10-3.98; p=0.02), but this risk did not persist after adjusting for age (hazard ratio, 1.89; 95% confidence interval, 0.99-3.59; p=0.05). CONCLUSION: Early research recommendations to sign an advance directive, particularly a do-not-resuscitate order, on nursing home admission may not be the best time for Chinese nursing home residents. Our results suggest that the best time to sign a do-not-resuscitate directive is as early as possible and no later than 2 years (742days) after admission if residents had not already done so. Residents on nasogastric tube feeding should be particularly targeted for discussions about do-not-resuscitate directives. SN - 1873-491X UR - https://www.unboundmedicine.com/medline/citation/28033524/Advance_directives_and_mortality_rates_among_nursing_home_residents_in_Taiwan:_A_retrospective_longitudinal_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-7489(16)30243-7 DB - PRIME DP - Unbound Medicine ER -