Dementia and Early Do-Not-Resuscitate Orders Associated With Less Intensive of End-of-Life Care: A Retrospective Cohort Study.
Elizabeth A Luth, Cynthia X Pan, Martin Viola and 1 others
PMID 33467864WHAT IT FOUND
Older adults with dementia who died in hospital received less intensive end-of-life care.
A DNR placed on admission was linked to lower ICU admission, ventilation, and intubation. DNRs placed later were not.
Key findings
01Patients with dementia were 42% less likely to be admitted to the ICU, 24% less likely to receive mechanical ventilation, 34% less likely to be intubated, and 28% less likely to receive any intensive care than patients without dementia.
02Having a DNR in place during hospitalization was associated with 43% greater odds of ICU admission and lower odds for the other intensive care measures.
03Compared with a DNR placed on admission, a DNR placed later during hospitalization or on the day of death was associated with 173% and 74% higher odds of ICU admission, and no DNR was associated with 33% higher odds.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used only hospital electronic records and diagnosis codes, so it could not confirm dementia severity or whether the care given matched patient and family preferences. It excluded 535 deaths because of data irregularities and 239 deaths because race or ethnicity was unknown or refused, so it did not cover all eligible deaths. It could not reliably account for prior nursing home residence, goals-of-care conversations, palliative or spiritual care consultations, or hospice referrals. The study cannot show that a DNR caused less intensive care, because preferences, clinical decisions, and reasons for admission were not measured. The sample came from two hospitals in New York City, so it may not apply to other settings.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that any DNR order reduces intensive care. Having a DNR was linked to 43% greater odds of ICU admission, and DNRs placed later were linked to higher odds of ICU admission than DNRs placed on admission.