Prevalence and related factors of do-not-resuscitate directives among nursing home residents in Taiwan.

ABSTRACT

OBJECTIVES: To report the prevalence of Do-Not-Resuscitate (DNR) directives and to explore the factors associated with the presence of DNR directives among nursing home residents in Taiwan. DESIGN: A cross-sectional, correlation study. SETTING: Seven nursing homes in southern Taiwan. PARTICIPANTS: Nursing home residents and their family surrogates. MEASUREMENTS Data were collected using chart abstraction and a questionnaire survey. We used multivariate logistic regression to analyze the associations between resident, family surrogate, and facility characteristics and the presence of DNR directives. RESULTS: Among the 201 nursing home residents, 33 (16.4%) had DNR directives and 91% of the directives had been put in place by family surrogates. Our data revealed that resident's age (OR = 1.06, 95% CI = 1.01-1.12), cognitive function score (OR = 0.91, 95% CI = 0.85-0.97), prior DNR discussion between physician and family surrogate (OR = 4.09, 95% CI = 1.53-10.96), and nursing home with DNR policy (OR = 17.71, 95% CI = 5.87-53.46) were independently and associated with the presence of a DNR directive. CONCLUSIONS: The prevalence of DNR directives among Taiwanese nursing home residents was lower than that in other countries. Our results point out the lack of DNR policy in most Taiwanese nursing homes and highlight the need for policy makers to implement further regulations. Meanwhile, education about advance directives is warranted to increase public and professional awareness and to facilitate empowerment of the increasing number of frail elderly nursing home residents in Taiwan.