Advance directives at end-of-life: nursing home resident preferences for artificial nutrition.
نویسندگان
چکیده
OBJECTIVE Nursing homes are increasingly the place where many Americans die. Thus, advance directives are critical to the preservation of the autonomous wishes at end-of-life. The purpose of this paper is to determine if preferences for artificial nutrition, as stated in the advance directives of nursing home residents, are honored in the last 2 months of life. DESIGN Secondary analysis. SETTING Six Maryland community nursing homes. PARTICIPANTS Fifty-seven consented residents (age 62 to 98) from the parent study who died during the study period. MEASUREMENTS Retrospective document review including advance directives and clinical care provided in the last 2 months of life. RESULTS Most of the nursing home residents in this sample refused feeding tubes, and these preferences were honored during the last 2 months of life (93%), despite some (17% to 26%) with documented weight loss. A small percentage (8.8%) of residents received feeding tubes at end-of-life and, of those, only 1 was consistent with advance directive preferences. Most advance directives in this study included feeding tube preferences. CONCLUSION In this nursing home sample, advance directives were significant documents guiding decisions on artificial nutrition, and feeding tubes were in fact uncommon at the end of life. The study suggests that advance care planning, quality palliative care training, and administrative support are necessary for the honoring of preferences. Future research is needed to examine more broadly tube-feeding practices and prevalence in nursing homes.
منابع مشابه
Title Advance directive and end - of - life care preferences amongChinese nursing home residents in Hong Kong
and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Abstract Objectives: The objectives of the present study were to describe the knowledge and preferences of Hong Kong Chinese older adults regarding advance directives and end-of-life care decisions, and to investigate the predictors of prefe...
متن کاملAdvance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong.
OBJECTIVES The objectives of the present study were to describe the knowledge and preferences of Hong Kong Chinese older adults regarding advance directives and end-of-life care decisions, and to investigate the predictors of preferences for advance directive and community end-of-life care in nursing homes. METHODS This was a cross-sectional survey conducted in 140 nursing homes in Hong Kong....
متن کاملAdvance care planning in nursing homes: correlates of capacity and possession of advance directives.
PURPOSE The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. DESIGN AND METHODS The authors used cross-sectional, c...
متن کاملSystematic implementation of an advance directive program in nursing homes: a randomized controlled trial.
CONTEXT Although advance directives are commonly used in the community, little is known about the effects of their systematic implementation. OBJECTIVES To examine the effect of systematically implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs. DESIGN Randomized controlled trial conducted June 1,...
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ورودعنوان ژورنال:
- Journal of the American Medical Directors Association
دوره 8 4 شماره
صفحات -
تاریخ انتشار 2007