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Centre for Policy on Ageing | |
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Changes in advance care planning in nursing homes before and after the Patient Self-Determination Act
— report of a 10-state survey | | Author(s) | Joan M Teno, Kenneth J Branco, Vincent Mor |
| Journal title | Journal of the American Geriatrics Society, vol 45, no 8, August 1997 |
| Pages | pp 939-944 |
| Keywords | Medical care ; Terminal care ; Rights [elderly] ; Residents [care homes] ; Nursing homes ; Law ; Wills ; Longitudinal surveys ; United States of America. |
| Annotation | The Patient Self-Determination Act (PSDA) implemented in 1991 has focused national attention in the US on the rights of patients to be involved in decision-making on the use of written advance directives (living wills). In 1990, 2175 nursing home residents in 270 long-term care facilities were sampled, and 2088 different patients from the same facilities were sampled in 1993, with 6-month follow-ups for both samples. Advance care planning was defined as the documentation in the medical record of a living will, an enduring power of attorney, a 'Do Not Resuscitate' (DNR) order, a 'Do Not Hospitalise' (DNH) order), or an order to forgo artificial nutrition or hospitalisation. Living wills increased from 4.2% in 1990 to 13.3% in 1993; and DNR orders increased dramatically from 31.1% to 51.5%. Striking variations in advance care planning were found: in 1990, DNR orders varied from 10.1% to 69.2% across the 10 states. With the exception of Oregon where 69.2% of patients already had a DNR order, states saw a 1.5 to 3.1 times increase in the rate of DNR orders in 1993 compared with 1990. The geographical variation in changes in advance care planning since implementation of the PSDA merits further research. (RH). |
| Accession Number | CPA-981026001 A |
| Classmark | LK: LV: IKR: KX: LHB: VR: VTH: 3J: 7T |
Data © Centre for Policy on Ageing |
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| ...from the Ageinfo database published by Centre for Policy on Ageing. |
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