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Gerontologist. 2016 Aug;56(4):714-22. doi: 10.1093/geront/gnv019. Epub 2015 Mar 20.

Nursing Home Residents' Preferences on Physician Orders for Life Sustaining Treatment.

Author information

1
Gerontology Research Consultant, Santa Monica, California. rahmananna1@gmail.com.
2
Gerontology Research Consultant, Los Angeles, California.
3
Davis School of Gerontology, University of Southern California, Los Angeles, CA.

Abstract

PURPOSE OF THE STUDY:

Previous studies examining preferences documented in Physician Orders for Life Sustaining Treatment (POLST) have found that most sampled POLSTs show a preference to limit care. These studies were conducted in states that are relatively ethnically homogeneous. This study investigated the POLST preferences of nursing home residents in an ethnically diverse state-California-that requires nursing homes to document whether residents execute POLST.

DESIGN AND METHODS:

Data were collected from POLST forms executed by 941 residents in a convenience sample of 13 nursing homes in Southern California. The study analyzed data from 4 POLST form items: signatory (resident vs. surrogate decision-maker) and care preferences related to: (a) resuscitation; (b) medical intervention; and (c) artificially administered nutrition. Descriptive, comparative, and regression analyses are reported at both individual and facility levels.

RESULTS:

Of reviewed POLSTs, 46.8% documented a preference for "do not resuscitate" (DNR); 47.3% documented limits on medical intervention; and 52% documented limits on artificially administered nutrition. Residents in nursing homes serving comparatively larger populations of older residents and White residents had lower odds of electing the full care option for each of the POLST's 3 care items; those in nursing homes serving comparatively larger populations of Hispanic residents had higher odds of electing long-term artificially administered nutrition.

IMPLICATIONS:

This study found lower rates of POLST choices limiting care than previous studies, possibly because the sampled nursing homes served a more ethnically- and age-diverse population. California's requirement that nursing homes document whether residents execute POLST also may have indirectly influenced choice patterns.

KEYWORDS:

End-of-life care; Nursing homes; Patient preferences; Physician Orders for Life Sustaining Treatment; Resident-centered care

PMID:
26035903
PMCID:
PMC4944535
DOI:
10.1093/geront/gnv019
[Indexed for MEDLINE]
Free PMC Article

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