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

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.