Preferences versus practice: life-sustaining treatments in last months of life in long-term care.

Journal of the American Medical Directors Association
Holly BiolaSheryl Zimmerman

Abstract

To determine prevalence and correlates of decisions made about specific life-sustaining treatments (LSTs) among residents in long-term care (LTC) settings, including characteristics associated with having an LST performed when the resident reportedly did not desire the LST. After-death interviews with 1 family caregiver and 1 staff caregiver for each of 327 LTC residents who died in the facility. The setting included 27 nursing homes (NHs) and 85 residential care/assisted living (RC/AL) settings in 4 states. Decedent demographics, facility characteristics, prevalence of decisions made about specific LSTs, percentage of time LSTs were performed when reportedly not desired, and characteristics associated with that. Most family caregivers reported making a decision with a physician about resuscitation (89.1%), inserting a feeding tube (82.1%), administering antibiotics (64.3%), and hospital transfer (83.7%). Reported care was inconsistent with decisions made in 5 of 7 (71.4%) resuscitations, 1 of 7 feeding tube insertions (14.3%), 15 of 78 antibiotics courses (19.2%), and 26 of 87 hospital transfers (29.9%). Decedents who received antibiotics contrary to their wishes were older (mean age 92 versus 85, P=.014). More than half (53.8...Continue Reading

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Mar 20, 2014·BMJ Supportive & Palliative Care·William SilvesterJane Gilchrist
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