MEDICAL-TREATMENT PREFERENCES OF NURSING-HOME RESIDENTS - RELATIONSHIP TO FUNCTION AND CONCORDANCE WITH SURROGATE DECISION-MAKERS

Objective: To describe treatment preferences of nursing home residents , concordance with decisions by self-selected proxies and to establish the relationship of sociodemographic and functional measures to decis ions. Setting and Subjects: 52 patient-proxy pairs at a Veterans Affai rs nursing home. Methods: Treatment preferences were elicited from res idents and proxies regarding cardiopulmonary resuscitation, mechanical ventilation, and intensive care unit care. Hospitalization, intraveno us antibiotics, intravenous fluid administration, and tube feeding wer e presented in three separate health scenarios. Concordance was determ ined for the entire interview and separately for each scenario. Treatm ent-seeking intensity and decision-making consistency were scored and used to explore associations with sociodemographic variables and funct ion. Results: Subjects were predominantly male (97%) and non-Hispanic white (74%); average age was 70 +/- 12 years, with 4 +/- 2.9 diagnoses . Residents accepted 70% of all treatments. The proportion of subjects accepting interventions declined parallel to health status in each sc enario. Only 7/52 (13%) subjects made inconsistent decisions. Resident treatment acceptance was inversely associated with GDS scores but not associated with any other sociodemographic or functional measure. Con cordance with proxies was no greater than chance. Proxies' decisions w ere not systematically biased against resident preferences or influenc ed by patient characteristics. Conclusions: Veterans desired most trea tments, but adjusted preferences according to health status and were n ot inconsistent. Depressive symptoms should be addressed prior to adva nce directive selection. The patient remains the best source of inform ation, but proxies' decisions exhibit no bias and are not affected by patient status.