Decisions to forgo hospitalization in advanced dementia

A nationwide study

Susan L. Mitchell, Joan Teno, Orna Intrator, Zhanlian Feng, Vincent Mor

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

OBJECTIVES: To examine the prevalence and factors associated with decisions to forgo hospitalization in nursing home (NH) residents with advanced dementia. DESIGN: Cross-sectional study. SETTING: All Medicare- and Medicaid-certified NHs within the 48 contiguous U.S. states. PARTICIPANTS: NH residents with advanced dementia were identified using Minimum Data Set (MDS) assessments completed close to April 1, 2000 (N=91,521). MEASUREMENTS: Multilevel, multivariate logistic regression identified factors independently associated with having a do-not-hospitalize (DNH) directive. Independent variables included subject characteristics (MDS), facility factors (On-line Survey of Certification of Automated Records), and hospital referral region (HRR) features (Dartmouth Atlas). RESULTS: Nationwide, 7.1% (n=6,518) residents with advanced dementia had DNH orders (range 0.7% in Oklahoma to 25.9% in Rhode Island). Resident characteristics associated with having a DNH order were older age, white, living will, durable power of attorney for health care, and total functional dependence. Controlling for these factors, DNH orders were more likely in residents of facilities with the following features: not part of a chain, urban location, special care dementia unit, fewer black residents, nurse practitioner or physician assistant on staff, higher staffing ratios, and location in HRRs with fewer intensive care unit admissions during terminal hospitalizations. CONCLUSION: Directives to forgo hospitalization for U.S. NH residents with advanced dementia are uncommon and are associated with the organizational features of the facilities caring for them and the intensity of end-of-life care practiced in the region, as well as individual resident characteristics.

Original languageEnglish (US)
Pages (from-to)432-438
Number of pages7
JournalJournal of the American Geriatrics Society
Volume55
Issue number3
DOIs
StatePublished - Mar 1 2007
Externally publishedYes

Fingerprint

Dementia
Hospitalization
Nursing Homes
Living Wills
Advance Directives
Physician Assistants
Terminal Care
Nurse Practitioners
Atlases
Medicaid
Certification
Medicare
Intensive Care Units
Referral and Consultation
Cross-Sectional Studies
Logistic Models
Datasets

Keywords

  • Decision-making
  • Dementia
  • Hospitalization
  • Nursing home
  • Palliative care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Decisions to forgo hospitalization in advanced dementia : A nationwide study. / Mitchell, Susan L.; Teno, Joan; Intrator, Orna; Feng, Zhanlian; Mor, Vincent.

In: Journal of the American Geriatrics Society, Vol. 55, No. 3, 01.03.2007, p. 432-438.

Research output: Contribution to journalArticle

Mitchell, Susan L. ; Teno, Joan ; Intrator, Orna ; Feng, Zhanlian ; Mor, Vincent. / Decisions to forgo hospitalization in advanced dementia : A nationwide study. In: Journal of the American Geriatrics Society. 2007 ; Vol. 55, No. 3. pp. 432-438.
@article{78cddd3844e94ef49c3393d5925b5433,
title = "Decisions to forgo hospitalization in advanced dementia: A nationwide study",
abstract = "OBJECTIVES: To examine the prevalence and factors associated with decisions to forgo hospitalization in nursing home (NH) residents with advanced dementia. DESIGN: Cross-sectional study. SETTING: All Medicare- and Medicaid-certified NHs within the 48 contiguous U.S. states. PARTICIPANTS: NH residents with advanced dementia were identified using Minimum Data Set (MDS) assessments completed close to April 1, 2000 (N=91,521). MEASUREMENTS: Multilevel, multivariate logistic regression identified factors independently associated with having a do-not-hospitalize (DNH) directive. Independent variables included subject characteristics (MDS), facility factors (On-line Survey of Certification of Automated Records), and hospital referral region (HRR) features (Dartmouth Atlas). RESULTS: Nationwide, 7.1{\%} (n=6,518) residents with advanced dementia had DNH orders (range 0.7{\%} in Oklahoma to 25.9{\%} in Rhode Island). Resident characteristics associated with having a DNH order were older age, white, living will, durable power of attorney for health care, and total functional dependence. Controlling for these factors, DNH orders were more likely in residents of facilities with the following features: not part of a chain, urban location, special care dementia unit, fewer black residents, nurse practitioner or physician assistant on staff, higher staffing ratios, and location in HRRs with fewer intensive care unit admissions during terminal hospitalizations. CONCLUSION: Directives to forgo hospitalization for U.S. NH residents with advanced dementia are uncommon and are associated with the organizational features of the facilities caring for them and the intensity of end-of-life care practiced in the region, as well as individual resident characteristics.",
keywords = "Decision-making, Dementia, Hospitalization, Nursing home, Palliative care",
author = "Mitchell, {Susan L.} and Joan Teno and Orna Intrator and Zhanlian Feng and Vincent Mor",
year = "2007",
month = "3",
day = "1",
doi = "10.1111/j.1532-5415.2007.01086.x",
language = "English (US)",
volume = "55",
pages = "432--438",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Decisions to forgo hospitalization in advanced dementia

T2 - A nationwide study

AU - Mitchell, Susan L.

AU - Teno, Joan

AU - Intrator, Orna

AU - Feng, Zhanlian

AU - Mor, Vincent

PY - 2007/3/1

Y1 - 2007/3/1

N2 - OBJECTIVES: To examine the prevalence and factors associated with decisions to forgo hospitalization in nursing home (NH) residents with advanced dementia. DESIGN: Cross-sectional study. SETTING: All Medicare- and Medicaid-certified NHs within the 48 contiguous U.S. states. PARTICIPANTS: NH residents with advanced dementia were identified using Minimum Data Set (MDS) assessments completed close to April 1, 2000 (N=91,521). MEASUREMENTS: Multilevel, multivariate logistic regression identified factors independently associated with having a do-not-hospitalize (DNH) directive. Independent variables included subject characteristics (MDS), facility factors (On-line Survey of Certification of Automated Records), and hospital referral region (HRR) features (Dartmouth Atlas). RESULTS: Nationwide, 7.1% (n=6,518) residents with advanced dementia had DNH orders (range 0.7% in Oklahoma to 25.9% in Rhode Island). Resident characteristics associated with having a DNH order were older age, white, living will, durable power of attorney for health care, and total functional dependence. Controlling for these factors, DNH orders were more likely in residents of facilities with the following features: not part of a chain, urban location, special care dementia unit, fewer black residents, nurse practitioner or physician assistant on staff, higher staffing ratios, and location in HRRs with fewer intensive care unit admissions during terminal hospitalizations. CONCLUSION: Directives to forgo hospitalization for U.S. NH residents with advanced dementia are uncommon and are associated with the organizational features of the facilities caring for them and the intensity of end-of-life care practiced in the region, as well as individual resident characteristics.

AB - OBJECTIVES: To examine the prevalence and factors associated with decisions to forgo hospitalization in nursing home (NH) residents with advanced dementia. DESIGN: Cross-sectional study. SETTING: All Medicare- and Medicaid-certified NHs within the 48 contiguous U.S. states. PARTICIPANTS: NH residents with advanced dementia were identified using Minimum Data Set (MDS) assessments completed close to April 1, 2000 (N=91,521). MEASUREMENTS: Multilevel, multivariate logistic regression identified factors independently associated with having a do-not-hospitalize (DNH) directive. Independent variables included subject characteristics (MDS), facility factors (On-line Survey of Certification of Automated Records), and hospital referral region (HRR) features (Dartmouth Atlas). RESULTS: Nationwide, 7.1% (n=6,518) residents with advanced dementia had DNH orders (range 0.7% in Oklahoma to 25.9% in Rhode Island). Resident characteristics associated with having a DNH order were older age, white, living will, durable power of attorney for health care, and total functional dependence. Controlling for these factors, DNH orders were more likely in residents of facilities with the following features: not part of a chain, urban location, special care dementia unit, fewer black residents, nurse practitioner or physician assistant on staff, higher staffing ratios, and location in HRRs with fewer intensive care unit admissions during terminal hospitalizations. CONCLUSION: Directives to forgo hospitalization for U.S. NH residents with advanced dementia are uncommon and are associated with the organizational features of the facilities caring for them and the intensity of end-of-life care practiced in the region, as well as individual resident characteristics.

KW - Decision-making

KW - Dementia

KW - Hospitalization

KW - Nursing home

KW - Palliative care

UR - http://www.scopus.com/inward/record.url?scp=33847261537&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33847261537&partnerID=8YFLogxK

U2 - 10.1111/j.1532-5415.2007.01086.x

DO - 10.1111/j.1532-5415.2007.01086.x

M3 - Article

VL - 55

SP - 432

EP - 438

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 3

ER -