ArticleThe American journal of hospice & palliative care2017
Advance Directives and Care Received by Older Nursing Home Residents.
Article in The American journal of hospice & palliative care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 18 citations in OpenAlex.
- Antibiotic prescription for older patients in end-of-life care: a randomized survey among physicians in Switzerland.BMC geriatrics · 2026Article
- Aspiration pneumonia in diabetic ketoacidosis: a decade-long analysis of occurrence , associated risk factors and clinical outcomes in 530,700 US hospitalizations.Diabetology & metabolic syndrome · 2025Article
- Advanced Care Plan Among Older Chinese in Residential Aged Care: A Retrospective Review.Journal of transcultural nursing : official journal of the Transcultural Nursing Society · 2025Article
- Article
- Prevalence and predictors of advance directive among terminally ill patients in Taiwan before enactment of Patient Right to Autonomy Act: a nationwide population-based study.BMC palliative care · 2022Article
- The Role of Regional and State Initiatives in Nursing Home Advance Care Planning Policies.The American journal of hospice & palliative care · 2021Article
- Life-sustaining treatment preferences in older patients when referred to the emergency department for acute geriatric assessment: a descriptive study in a Dutch hospital.BMC geriatrics · 2021Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundResearch shows variable success as to whether care provided aligns with individual patient preferences as reflected in their advance directives (AD).
objectiveWe aimed to study AD status and subsequent care received in older nursing home (NH) residents deemed at risk for infections and care transitions: those with a urinary catheter (UC), feeding tube (FT), or both. Design/participants/measurements: A subgroup analysis of a prospective cohort of 90 residents with a UC and/or FT from 15 NHs in southeast Michigan. Outcomes assessed at enrollment and at 30-day intervals were hospitalizations and antibiotic use. The ADs were divided as follows: (1) comfort oriented: comfort measures only, no hospital transfer; (2) palliative oriented: comfort focused, allowing hospital transfer (except intensive care unit), antibiotic use, but no cardiopulmonary resuscitation; (3) usual care: full code, no limitations to care. We calculated incidences for these outcomes.
resultsSeventy-eight (87%) residents had ADs: 18 (23%) comfort oriented, 32 (41%) palliative oriented, and 28 (36%) usual care. The groups did not differ regarding demographics, comorbidity, function, device presence, or time in study. Using the usual care group as comparison, the comfort-oriented group was hospitalized at a similar rate (Incidence rate [IR] = 15.6/1000 follow-up days vs IR = 8.8/1000 follow-up days, Incident rate ratio [IRR] 0.6 [95% confidence interval, CI, 0.3 -1.1], P value .09) but received fewer antibiotics (IR = 18.9/1000 follow-up days vs IR = 7.5/1000 follow-up days, IRR 0.4 [95% CI, 0.2-0.8], P value .005).
conclusionNursing home residents with comfort-oriented ADs were hospitalized at a rate similar to those with usual-care ADs but received fewer antibiotics, although the small sample size of this analysis suggests these findings deserve further study.
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