The Factors Associated with the Do-Not-Resuscitate Decision or Intention Among Elderly Nursing Home Residents
Date Issued
2011
Date
2011
Author(s)
Tseng, Yi-Ping
Abstract
Background: The majority of service population of Taiwan’s nursing homes are disabled senior residents. The elderly stage is approaching the stage of death. A good death is a critical issue for disabled senior residents. However, the affecting factors of do-not-resuscitate (DNR) decision or intention among disabled senior residents at nursing homes are rarely explored in the literature. This study was to investigate the factors associated with the DNR decision or intention among elderly nursing home residents in Taiwan.
Methods: This was a cross-sectional and correlational study design using a purposive sampling to recruit ≧ 65 year-old residents and their family(n = 177) from a nursing home of the district hospital in northern Taiwan. The measurement tools included Barthel Index, Short Portable Mental Status Questionnaire, Geriatric Depression Scale, and self-designed constructive questionnaires. Data were collected by questionnaires, face to face interview, and medical chart review including characteristics of elderly residents and family surrogates and DNR decision or intention. Data were analyzed using multivariate logistic regressions of SPSS 15.0.
Results: Only 9% of senior residents signed DNR. The majority of family (79%) surrogates made the DNR decision for senior residents. Multivariate logistic regression showed that resident’s age (OR = 1.16, 95% CI = 1.05 - 1.28), divorced and widowed residents (OR = 7.95, 95% CI = 1.33 - 47.72), resident with cancer (OR = 9.70, 95% CI = 1.59- 59.10), lung disease (OR = 5.44, 95% CI = 1.29 - 22.94), or muscle and skeletal disease (OR = 4.82, 95% CI = 1.12 - 20.75) were significant predictor for resident’s DNR decision. In addition, most elderly (56.7%) and their family surrogates (76.9%) agreed with signed DNR for senior residents. Family consensus of DNR (OR = 28.80, 95% CI = 2.43 - 341.09) was the only significant factor associated with resident’s DNR intention.
Conclusions: Most elderly residents of nursing homes were cognitive impairment and their DNR decisions were made by family surrogates. There was a discrepancy between senior residents and their family proxies on DNR decision and intention. Facilitating family consensus on resident’s DNR to making actual DNR decision and end-of-life care are important for nursing home elderly residents. Future studies can conduct a qualitative study to understand elderly resident’s and family proxy’s perspectives and to establish advanced care planning early. Thus, the end-of-life care was determined by elderly resident’s self-determination.
Subjects
Nursing home
elder resident
family surrogate
Do-Not-Resuscitate decision or intention
predictors
SDGs
Type
thesis
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