ArticleJournal of the American Geriatrics Society2026
Predictors of Advance Directive Changes in Ontario Nursing Home Residents: A Case-Control Study.
Article in Journal of the American Geriatrics Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- Predictors of Advance Directive Changes in Ontario Nursing Home Residents: A Case-Control Study.Journal of the American Geriatrics Society · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundGoals of care (GOC) discussions between the clinical team and nursing home (NH) residents provide the basis for decision-making on advance directives (AD) that include do-not-resuscitate (DNR) and do-not-hospitalize (DNH). Optimal timing and prompts for initiating GOC discussions are unclear. This study investigates recent emergency department (ED) use and clinical and demographic factors associated with subsequent AD changes.
methodsNested case-control study within a population-based retrospective cohort using linked administrative health care data of individuals admitted to NHs in Ontario, Canada between 2013 and 2017 and then followed up until 2019. Eligible cases and controls were residents with and without an AD change between 2013 and 2019, respectively. Cases and controls were matched 1:1 by sex, composite AD at NH admission, NH admission date (±90 days), and birthdate (±365 days). The primary outcome was incident AD change, and exposures included recent ED use (either ED visits discharged back to NH or ED visits that resulted in hospitalization) and clinical and demographic variables measured at the time of documented AD change. Conditional logistic regression provided adjusted odds ratios for associations between exposures and incident AD change.
resultsThe cases and controls (27,942 residents) had a mean age of 84 years at NH admission and 67.1% were female. 48.3% had a baseline AD of "DNR Only" while the remaining were evenly divided between "Full Code" and "DNR+DNH." The estimated adjusted odds ratio of AD change was 2.01 (95% CI, 1.83-2.21) in residents with recent hospitalization, 1.89 (95% CI, 1.67-2.13) in those having end-stage disease, and 1.82 (95% CI, 1.56-2.12) in residents who were mostly bedfast.
conclusionsA recent hospitalization, end-stage disease, or being bedfast are significant predictors of AD change. These important predictors exhibited by NH residents present opportunities to reassess GOC.
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