257213 Do women make different choices about end of life care? A national study of gender differences in Do Not Resuscitate (DNR) orders among nursing home residents

Monday, October 29, 2012

Dana B. Mukamel, PhD , Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA
Lauren Bailey, MS , Health Policy Research Institute, University of California, Irvine, Irvine
Heather Ladd, MS , Health Policy Research Institute, University of California, Irvine, Irvine
Helena Temkin-Greener, PhD , Department of Community and Preventive Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
End-of-life (EOL) treatment choices are complex and depend on a myriad of health, personal and cultural factors and the interplay. This study we present is the first to our knowledge to examine gender differences in choice of DNR orders among nursing-home residents, not only as a main effect, but as they interact with a large number of other important health, socio-demographic and cultural characteristics. This is a retrospective study of the national Minimum Data Set (MDS) files providing information on 284,986 decedent residents in CY2003-2006. We estimated logistic models in which having a DNR order or not was the dependent variable and all personal and health status characteristics were independent variables. 67% of women and 60% of men had a DNR order. Significant predictors of DNR included gender, age, race, marital status, education, English speaking, having other types of advance directives, cognitive status, depression, aggressive behavior and health status. The marginal effect of gender on these variables varied, from being significant for all levels of predicted probabilities (0 to 1) to being significant only over some of the range of the predicted probabilities. For example, men and women of older age behave differently with regard to choosing DNR for predicted probabilities between 0 and 0.5 but not at higher probabilities, suggesting that for very sick individuals' age does not affect the choice of DNR. This study suggests that women's views of DNR differ from those of men and practitioners should be sensitive to these gender differences in EOL treatment discussion.

Learning Areas:
Public health or related organizational policy, standards, or other guidelines
Social and behavioral sciences

Learning Objectives:
1. Identify gender differences in attitudes towards DNR orders 2. Evaluate the implications of these differences for end-of-life discussions

Keywords: End-of-Life Care, Nursing Homes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a professor at the University of California, Irvine and an expert in health services research and have conducted extensive research on nursing homes quality of care and end-of-life practices.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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