Implementing a "Do-Not-Resuscitate" (DNR) policy in a nursing home

J Am Geriatr Soc. 1989 Jun;37(6):544-8. doi: 10.1111/j.1532-5415.1989.tb05687.x.

Abstract

During implementation of a new Do-Not-Resuscitate (DNR) policy in New York State, decisions by 233 nursing home patients of their surrogates were evaluated. Eighteen patients with capacity (mean age +/- SD = 76.4 +/- 12.1 years) chose DNR; 30 patients with capacity (mean age +/- SD = 76.2 +/- 10.7 years) chose to be resuscitated (CODE); 54 patients without capacity, (mean age +/- SD = 86.1 +/- 9.1 years) had surrogates who chose DNR; and 131 patients without capacity and with surrogates (mean age +/- SD = 81.9 +/- 9.8 years) remained CODE. Most patients with capacity who chose DNR had multiple sclerosis, while most choosing CODE had strokes. Most patients who lacked capacity had dementia. Forty-five percent of surrogates did not respond regarding CODE status during the three-month study interval, and 10% wanted additional time to decide. Patient age appeared to be a factor in surrogate choice for DNR but not in patients with capacity making their own decision. Reasons for patients with capacity choosing DNR are discussed; perceived quality of life and premorbid feelings by patients help in the decision-making process.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Decision Making
  • Euthanasia*
  • Euthanasia, Passive*
  • Female
  • Homes for the Aged
  • Humans
  • Informed Consent
  • Legislation, Medical
  • Male
  • Middle Aged
  • New York
  • Nursing Homes*
  • Patient Selection*
  • Quality of Life
  • Resuscitation*