Using data from the Agency for Healthcare Research and Quality's Nursing Home Component of the 1996 Medical Expenditure Panel Survey, this paper examined 3714 non-comatose residents aged 19 to 103 to determine which residents were more likely to have do-not-resuscitate orders (DNR), do-not-hospitalize orders (DNH), or other directives with regard to feeding, medication, or treatment (FMT). Residents in for-profit facilities, African and Hispanic Americans (compared to Whites), residents who established their own goals, and those with below a 9th-grade education were less likely to have a DNR. In contrast, increased age, the use of wheelchairs or trunk restraints, and having long-term memory problems were correlated with a greater probability of having a DNR, as was having long-term care insurance (compared to individuals with both Medicare and Medicaid). Residents with below a 9th-grade education and those who displayed socially inappropriate behavior were less likely to have a DNH. A greater likelihood of having a DNH was associated with increased age, hemiplegia/hemiparesis, chewing problems and the use of trunk restraints. African and Hispanic Americans, and residents with a below a 9th-grade education were also less likely to have an FMT, as were those who had anemia. In contrast, those who established their own goals, had arthritis, deep vein thrombosis, emphysema/copd, transient ischemic attacks, long-term memory problems, used a wheelchair, had no family contact, or were resistant to care at least daily, were more likely to have an FMT. Concerns regarding rationing warrant investigation into the impact of these differences on healthcare expenditures.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: 1.List indicators that link advance directives to socioeconomic factors. 2.Articulate the procedure for obtaining an advance directive. 3.Recognize key ethical and organizational considerations regarding the use of advance directives
Keywords: Long-Term Care, Nursing Homes
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: N/A
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.