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Honoring End-of-Life Wishes

‘Do-not-hospitalize’ orders can help reduce hospital stays, but only a small portion of residents have them

Only a small percentage of patients with 'Do Not Resuscitate' orders also have 'Do Not Hospitalize' orders, according to a new study led by researchers at UAlbany's School of Public Health.

ALBANY, N.Y. (May 18, 2017) -- Do-not-hospitalize (DNH) orders help reduce the number of hospital stays and emergency department visits for nursing home residents, but they are used by only a small percentage of patients, according to a new study led by researchers at UAlbany.

Publishing in the May issue of JAMDA, the authors conducted a cross-sectional study of residents in New York State skilled nursing facilities. They found that while 61 percent of nursing home residents have ‘do-not-resuscitate’ orders, 12 percent had feeding restrictions, and only six percent have DNH orders in place.

"We set out with the goal of examining whether an advanced directive, DNH orders would be effective in reducing hospital/emergency department transfers,” said Taeko Nakashima, a visiting assistant professor in the department of Health Policy Management and Behavior at UAlbany’s School of Public Health. “The results show that for residents without DNH orders, the odds of being transferred to a hospital were significantly higher.”

"The findings suggest that residents' end-of-life care decisions were respected and honored. Efforts should be made to encourage nursing home residents to complete DNH orders to promote integration of the resident's values and goals in guiding care provision toward the end of life,” said Yuchi Young, UAlbany Associate Professor of Health Policy, Management and Behavior.

According to the findings, residents with DNH orders had significantly fewer unnecessary hospital stays and emergency department visits in their last 90 days of life than residents without them, the researchers reported. The orders also helped reduce hospital stays for residents with dementia.

Nakashima, who is also on the faculty of the Department of Economics at Rutgers University, authored the study with Young and Wan-Hsiang Hsu of the New York State Department of Health’s Bureau of Environmental and Occupational Epidemiology.

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