Decision-making factors regarding resuscitate and hospitalize orders by families of elderly persons on admission to a Japanese long-term care hospital

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  • Hirakawa Yoshihisa
    Department of Geriatrics, Graduate School of Medicine, Nagoya University
  • Masuda Yuichiro
    Department of Geriatrics, Graduate School of Medicine, Nagoya University
  • Kuzuya Masafumi
    Department of Geriatrics, Graduate School of Medicine, Nagoya University
  • Iguchi Akihisa
    Department of Geriatrics, Graduate School of Medicine, Nagoya University
  • Uemura Kazumasa
    Center of Medical Education, School of Medicine, Nagoya University

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Other Title
  • 療養型病床群１施設における心肺蘇生および急性期病院への転院に関する家族の希望
  • リョウヨウガタ ビョウショウグン 1 シセツ ニ オケル シンハイ ソセイ オヨビ キュウセイキ ビョウイン エノ テンイン ニ カンスル カゾク ノ キボウ

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Abstract

Background: Because long-term care facilities are being asked to care for more and more residents who are dying, the facilities require that new residents and families make decisions regarding their end-of-life care at the time of the admission process. An advance directive including "do-not resuscitate directives (DNR)" or "do-not-hospitalize directives (DNH)" is a written document that afford individuals the opportunity to determine the type and extent of end-of-life care when they are incapable of participation in medical decision making. It is expected that Japanese elderly and families make individual decisions regarding end-of-life care by a Japanese-style decision-making model including advance directives. The purpose of this study was to explore families' decision-making factors regarding cardiopulmonary resuscitate (CPR) and hospitalize orders in a long-term care hospital.<br> Method: We assessed 70 admissions in a long-term care hospital in Aichi prefecture from April 2005 to September 2006. All residents were divided into two groups according to their CPR or hospitalize order. Data on the admission characteristics of the residents were collected from medical charts.<br> Results: The prevalence of older age, functional dependence, and illness did not vary significantly with CPR or hospitalize order recorded by families, however, significant variation among physicians existed in the CPR and hospitalize orders.<br> Conclusion: Wide variation in the likelihood of having CPR and hospitalize orders among physicians who explain an advance directive suggests a need for standardized methods for eliciting the end-of-life preferences of residents and families on admission to long-term care hospitals.<br>

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