To investigate whether do not attempt resuscitation (DNAR) orders can be implemented in a standard nursing home in Japan, where routine DNAR orders are not yet common in many facilities including hospitals.
Method:
Ninety-eight residents in a 100-bed nursing home were evaluated. All of the eligible residents and/or their family members were asked whether they wanted to receive resuscitation, including mechanical ventilation.
Result:
The residents were 54 to 101 years of age (mean 83.3), with 27 males and 71 females. After administering the questionnaire, 92 (94%) patients did not want resuscitation and mechanical ventilation.
Conclusion:
In a nursing home, it was possible to obtain advance directives by which most residents/families rejected resuscitation and mechanical ventilation. This could avoid unnecessary and undesirable resuscitation procedures.
AitaKKaiI.Withdrawal of mechanical ventilation from dying patients at emergency and critical care facilities in Japan: a qualitative study with physicians. Nihon kyukyu igakukai zasshi. 2009;20(1):16–30.
2.
DeekenA.The need for death education. Gan To Kagaku Ryoho. 1992;19(9):1247–52. In Japanese
3.
ChanTHChanFMTinAFChowAYChanCL.Death preparation and anxiety: a survey in Hong Kong. Omega (Westport). 2006-2007;54(1):67–78.
4.
Patient Self-Determination Act of 1991; Section 4206 and 4751 of the Omnibus Reconciliation Act of 1990.
5.
Messinger-RapportBJKamelHK. Predictors of Do Not Resuscitate Orders in the Nursing Home. J Am Med Dir Assoc. 2005;6(1):18–21.
6.
"Asia: Japan: Most Elderly Nation". The New York Times. 2006-07-01. Retrieved 2008-01-07.
TerryMZweigS. Prevalence of Advanced Directives and Do-Not-Resuscitate Orders in Community Nursing Facilities. Arch Fam Med. 1994;3(2):141–145.
9.
TingFHMokE. Advance directives and life-sustaining treatment attitudes of Hong Kong Chinese elders with chronic disease. Hong Kong Med J. 2011;17(2):105–111.
10.
ReillyBMMagnussenCRAshJPapaLWagnerM. Can we talk? Inpatient discussions about advance directives in a community hospital. Attending physicians’ attitudes, their inpatients’ wished, and reported experience. Arch Intern Med. 1994;154(20):2299–2308.
11.
HuiEHoSCTsangJLeeSHWooJ. Attitudes toward life-sustaining treatment of older persons in Hong Kong. J Am Geriatr Soc. 1997;45(10):1232–1236.
12.
AdamsDHSneddenDP. How misconceptions among elderly patients regarding survival outcomes of inpatient cardiopulmonary resuscitation affect do-not-resuscitate orders. J Am Osteopath Assoc. 2006;106(7):402–404.
13.
MeadGETurnbullCJ. Cardiopulmonary resuscitation in the elderly: patients’ and relatives’ views. J Med Ethics. 1995;21(1):39–44.
14.
MurphyDJBurrowsDSantilliS. The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation. N Eng J Med. 1994;330(8):545–549.
15.
OsakabeYTakahashiYNariharaKKanesakaSImaiK.Emergency medical care and the aged. Nihon kyumeiiryo kennkyukai zasshi. 1996;10:173–180.
16.
GoodmanMDTarnoffMSlotmanGJ. Effect of advance directives on the management of elderly critically ill patients. Crit Care Med. 1998;26(4):701–704.
17.
EstebanAGordoFSolsonaJF. Withdrawing and withholding life support in the intensive care unit: A Spanish prospective multi-center observation. Intensive Care Med. 2001;27(11):1744–1749.
18.
KavicSMAtwehNPossentiPPIvyME. The role of advance directives and family in end-of –life decisions in critical care units. Conn Med. 2003;67(9):531–534.
19.
CamhiSLMercadoAFMorrisonRS. Deciding in the dark: Advance directives and continuation of treatment in chronic critical illness. Crit Care Med. 2009;37(3):919–925.
20.
KelleyCGLipsonARDalyBJDouglasSL. Use of advance directives in the chronically critically ill. JONAS HealthcLaw Ethics Regul. 2006;8(2):42–47.
21.
HalpernNAPastoresSMChouJFChawlaSThalerHT. Advance directives in an oncologic intensive care unit: a contemporary analysis of their frequency, type, and impact. J Palliat Med. 2011;14(4):483–489.
22.
CohenILLambrinosJFeinIA. Mechanical ventilation for the elderly patient in intensive care. Incremental changes and benefits. JAMA. 1993;269(8):1025–1029.
23.
ElyEWEvansGWHaponikEF. Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Ann Intern Med. 1999;131(2):96–104.
24.
TangEYHsuLFLamKNPangWS. Critically ill elderly who require mechanical ventilation: the effects of age on survival outcomes and resource utilization in the medical intensive care unit of a general hospital. Ann Acad Med Singapore. 2003;32(5):691–696.
25.
BarnatoAEAlbertSMAngusDCLaveJRDegenholtzHB. Disability among elderly survivors of mechanical ventilation. Am. J. Respir. Crit. Care Med. 2011;183(8):1037–1042.
