This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Changes in the Way We Die

Katherine A. Hesse, MSW, MD

Arch Intern Med. 1995;155(14):1513-1518.

Abstract
Background
This study examines the use of advance directives, limitations of treatment, and medical interventions during the terminal hospitalization of the old-old. Study periods before and after the implementation of the Patient Self-Determination Act of 1990 were chosen to determine if there has been a change in terminal care.

Methods
Chart review was performed for all patients 85 years and older who died in the hospital during 1988 and 1993. Patient characteristics, presence of advance directives, do-not-resuscitate orders, and other treatment limitations were noted as were interventions listed in the Medical Directive.

Results
Less than 12% of the 167 study patients had an advance directive. Length of stay for these terminal admissions decreased from 18.5 to 9.6 days. Ninety-five percent of the patients were "do not resuscitate" by time of death, but orders were written sooner in 1993-75% within 24 hours of admission. Patients with early do-not-resuscitate orders had fewer high-intensity interventions. More patients had "comfort measures only" during the study period. An overall decrease in high-intensity interventions and a specific decrease in the use of transfusions, invasive tests, minor surgery, and cardiopulmonary resuscitation was seen.

Conclusion
Patients 85 years and older are receiving fewer high-intensity interventions during their terminal hospitalizations. More attention is being paid to comfort and few are receiving cardiopulmonary resuscitation. There is little reference to formal advance directives in decision making for these patients.

(Arch Intern Med. 1995;155:1513-1518)

Author Affiliations
From Mount Auburn Hospital, Cambridge, Mass.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

End-of-Life Treatment Preferences of Persons With Serious Mental Illness
Foti et al.
Psychiatr. Serv. 2005;56:585-591.
ABSTRACT | FULL TEXT  

Cardiopulmonary resuscitation is not addressed in the admitting medical records for the majority of patients who undergo CPR in the hospital
Mirza et al.
AM J HOSP PALLIAT CARE 2005;22:20-25.
ABSTRACT  

Freud's Physician-Assisted Death
McCue and Cohen
Arch Intern Med 1999;159:1521-1525.
FULL TEXT  

Community Physicians Who Provide Terminal Care
Hanson et al.
Arch Intern Med 1999;159:1133-1138.
ABSTRACT | FULL TEXT  

Death and End-of-Life Planning in One Midwestern Community
Hammes and Rooney
Arch Intern Med 1998;158:383-390.
ABSTRACT | FULL TEXT  

Acute Care Costs of the Oldest Old: They Cost Less, Their Care Intensity Is Less, and They Go to Nonteaching Hospitals
Perls and Wood
Arch Intern Med 1996;156:754-760.
ABSTRACT