Timing of Do-Not-Resuscitate Orders for Hospitalized Older Adults Who Require a Surrogate Decision-Maker

• Published in: Journal of the American Geriatrics Society (JAGS) 2011-07, Vol.59 (7), p.1326-1331
• Main Authors: Torke, Alexia M., Sachs, Greg A., Helft, Paul R., Petronio, Sandra, Purnell, Christianna, Hui, Siu, Callahan, Christopher M.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Decision Making; end of life; Ethics; Female; General aspects; Hospitalization; Humans; Legal Guardians; Male; Medical sciences; Older people; proxy; Public health. Hygiene; Public health. Hygiene-occupational medicine; resuscitation; Resuscitation Orders; Retrospective Studies; Right to die; Teaching. Deontology. Ethics. Legislation; Time Factors; Timing issues
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2011.03480.x

OBJECTIVES: To examine the frequency of surrogate decisions for in‐hospital do‐not‐resuscitate (DNR) orders and the timing of DNR order entry for surrogate decisions. DESIGN: Retrospective cohort study. SETTING: Large, urban, public hospital. PARTICIPANTS: Hospitalized adults aged 65 and older over a 3‐year period (1/1/2004–12/31/2006) with a DNR order during their hospital stay. MEASUREMENTS: Electronic chart review provided data on frequency of surrogate decisions, patient demographic and clinical characteristics, and timing of DNR orders. RESULTS: Of 668 patients, the ordering physician indicated that the DNR decision was made with the patient in 191 cases (28.9%), the surrogate in 389 (58.2%), and both in 88 (13.2%). Patients who required a surrogate were more likely to be in the intensive care unit (62.2% vs 39.8%, P