THE FREQUENCY OF DO-NOT-RESUSCITATE ORDER IN AGED INPATIENTS - EFFECTOF PATIENT-RELATED AND NON-PATIENT-RELATED FACTORS

Objective: The purpose of this study was to examine the effect of pati ent- and non-patient-related factors (co-morbidity, demographics, and method of surveillance) on the frequency of ''do-not-resuscitate'' (DN R) orders in aged inpatients. Methods: On a geriatric ward, during thr ee different periods within 1 year, we used two different methods of d ata collection (with or without a form) and two different time-frames (prevalence or incidence) in studying the frequency of DNR orders, dem ographic data and the Pre-Arrest Morbidity (PAM) Index. Results: In a sample of 261 patients the DNR decision was related to patient-related factors, including the PAM score and age. Only 3 patients with a scor e above 4 had no DNR order and in the group of 142 patients > 83 years 85 (59.9%) had a DNR order, compared to 52 (43.7%) of the 119 patient s of 83 years or less (p < 0.05). In contrast, gender and marital stat us were not related to the presence of a DNR order. The variables PAM score, age, form and time-frame classified 76.6% of the cardiopulmonar y resuscitation (CPR) decisions correctly and 71.5% of the DNR decisio ns correctly. Without attention to the resuscitation decision, the wri tten DNR order frequency decreased significantly from 64-59% to 23%. A n explanation for this variance may be the passive process of data col lection, a non-patient-related factor. Conclusions: The DNR decision i s related to the PAM index score and age. The variance in DNR decision s is partly related to the method of data collection, a non-patient-re lated factor in DNR decision-making. Without attention to the DNR/ CPR decision, the DNR frequency decreased markedly.