Life-sustaining treatment decisions for nursing home residents: who discusses, who decides and what is decided?

J Am Geriatr Soc. 1999 Jan;47(1):82-7. doi: 10.1111/j.1532-5415.1999.tb01905.x.


Objective: To evaluate whether nursing home residents and their families reported discussions about life-sustaining treatment with their physicians, the relationship between such discussions and orders to limit therapy, and predictors of physician-patient communication about life-sustaining treatment.

Design: Cross-sectional interviews and retrospective chart abstraction.

Setting: Three regions: West Coast, New England, Western.

Sample: A total of 413 nursing home residents, 363 family/surrogate interviews, and 192 resident interviews.

Main outcome measures: Measured were (1) physician-resident communication about life-sustaining treatment and (2) presence of an advance directive or do not resuscitate (DNR) order in resident's chart.

Results: Seventy-four percent of residents had DNR orders, and 32% had advance directives; only 29% of residents reported discussions about life-sustaining treatment. Of residents with DNR orders who could have participated in discussions about life-sustaining treatment, nearly half reported they had not discussed CPR with their caregivers. Older age, longer duration of time living in nursing home, location in a New England nursing home, physician-family member discussion, and the presence of an advance directive in the medical chart were positively associated with having DNR orders. Physician-resident discussion was not associated with having a DNR order. For the subsample of interviewed residents, age and a diagnosis of cognitive impairment were negatively associated with a physician-resident discussion about life-sustaining treatment, whereas the likelihood of having a discussion increased with increasing numbers of medical diagnoses.

Conclusions: Chart orders to limit therapy are common, but physician-resident discussions about life-sustaining treatments are not. Far more family members than residents report such discussions with the resident's physicians.

MeSH terms

  • Adult
  • Advance Directives / psychology*
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Communication*
  • Cross-Sectional Studies
  • Decision Making*
  • Family / psychology*
  • Female
  • Humans
  • Life Support Care / psychology*
  • Male
  • Mental Competency
  • Middle Aged
  • Nursing Homes*
  • Physician-Patient Relations*
  • Resuscitation Orders*
  • Retrospective Studies
  • Surveys and Questionnaires