Medical Care in Old Age: What Do Nurses in Long-Term Care Consider Appropriate?
Gillick, Muriel R.
Mendes, Marc L.
Journal of the American Geriatrics Society. 1996 Nov; 44(11): 1322-1325.
OBJECTIVES: To determine whether nurses working in a long-term care institution, who are knowledgeable about the full range of conditions common among older people, favor limitations of treatment in old age; and to study whether the level of intensity of care they regard as appropriate varies with the overall health status of the older individual. DESIGN: Participants were asked to complete an intervention-specific advance directive for themselves, with scenarios representing terminal illness, dementia plus chronic illness, chronic illness in a nursing home resident, chronic illness in a community-dwelling older person, and a robust, community-dwelling older person. SETTING: A 725-bed long-term care institution, with residents having a mean age of 88 years and a wide range of physical and cognitive deficits. PARTICIPANTS: Full-time nurses at the long-term care facility were eligible and were given survey instruments; 102 of the 145 eligible nurses completed the questionnaire. MEASUREMENTS: The unit of analysis is the refusal rate, defined as the mean number of refusals of interventions for each respondent. MAIN RESULTS: The overall refusal rate for all five scenarios taken together was 72.1%. The refusal rate in the case of terminal illness was 90.9%, in the case of dementia plus chronic illness 81.8%, in the case of dementia in a nursing home 69.1%, for a homebound older person with chronic illness 70.9%, and for a previously healthy 85-year-old person living in the community, 50.0% (P less than .001). CONCLUSIONS: Nurses working in a long-term care institution have strong preferences about limiting a variety of interventions in old age. The greater the degree of physical and cognitive impairment, the more limitations they favor. This suggests the necessity of expanding advance planning to include a discussion of what constitutes appropriate treatment in a broad range of circumstances.
Adults; Advance Care Planning; Advance Directives; Aged; Allowing to Die; Artificial Feeding; Attitudes; Biomedical Technologies; Blood; Cancer; Chronically Ill; Dementia; Drugs; Health; Health Status; Home Care; Illness; Life; Long-Term Care; Nurses; Nursing Homes; Patient Care; Prolongation of Life; Quality of Life; Rehabilitation; Renal Dialysis; Resuscitation; Surgery; Survey; Terminally Ill; Treatment Refusal; Ventilators;
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