Use of the Physician Orders for Life-Sustaining Treatment program in Oregon nursing facilities: beyond resuscitation status

J Am Geriatr Soc. 2004 Sep;52(9):1424-9. doi: 10.1111/j.1532-5415.2004.52402.x.


Objectives: Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life-Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms.

Design: Telephone survey; on-site POLST form review.

Setting: Oregon nursing facilities.

Participants: One hundred forty-six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review.

Measurements: A telephone survey; onsite POLST form reviews.

Results: In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do-not-resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (> or = 85, n=167) were more likely than the young old (65-74, n=48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration.

Conclusion: The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life-extending treatment, and advanced age was associated with orders to limit treatments.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Care Planning / organization & administration*
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Attitude of Health Personnel
  • Attitude to Health
  • Choice Behavior
  • Enteral Nutrition
  • Fluid Therapy
  • Forms and Records Control
  • Guideline Adherence
  • Health Services Research
  • Humans
  • Life Support Care / organization & administration*
  • Life Support Care / psychology
  • Medical Audit
  • Medical Records*
  • Nursing Homes / organization & administration*
  • Oregon
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / organization & administration*
  • Resuscitation Orders* / psychology
  • Surveys and Questionnaires


  • Anti-Bacterial Agents