Skip to main content

Table 4 Association between DNR and DNH directives and end-of-life outcomes for LTCH residents at 90-day follow-up (T2) by state of health instability at baseline

From: Outcomes of advance care directives after admission to a long-term care home: DNR the DNH?

  End-of-life outcomes (T2) (adjusted odds ratio; 95% CI)a
Remained in LTC
CHESSb Score
Admitted to Hospital Died Discharged
Other Settingc
Discharged
Home
0 1–2 3+
Do Not Hospitalize (ref = Not Present)
 Health instability at baseline (T1) 0 1.04 (1.02–1.07) 1.10 (1.03–1.19) 0.67 (0.65–0.69) 1.48 (1.38–1.58) 0.92 (0.79–1.06) 0.91 (0.79–1.05)
1–2 0.92 (0.90–0.95) 1.07 (1.03–1.12) 0.63 (0.61–0.65) 1.46 (1.40–1.52) 0.91 (0.81–1.04) 1.00 (0.86–1.17)
3+ 0.76 (0.68–0.85) 0.81 (0.76–0.87) 0.47 (0.43–0.52) 1.48 (1.37–1.60) 0.82 (0.60–1.11) 0.72 (0.44–1.16)
Do Not Resuscitate (ref = Not Present)
 Health instability at baseline (T1) 0 1.08 (1.05–1.11) 1.32 (1.21–1.45) 0.90 (0.87–0.92) 1.36 (1.25–1.49) 0.82 (0.72–0.94) 0.58 (0.51–0.65)
1–2 0.91 (0.88–0.94) 1.19 (1.12–1.26) 0.82 (0.80–0.85) 1.38 (1.30–1.47) 0.85 (0.74–0.98) 0.55 (0.48–0.63)
3+ 0.75 (0.64–0.86) 0.85 (0.77–0.95) 0.63 (0.57–0.71) 1.11 (0.98–1.26) 0.76 (0.51–1.11) 0.53 (0.32–0.87)
  1. aMulti-state transition models adjusted for: physician visits, age, gender, marital status, ADL Hierarchy scale score, Cognitive Performance Scale score, diagnosis (binary variables for COPD, pneumonia, diabetes, arthritis, renal failure, UTI, ADRD, heart failure, cancer, depression), facility size, data of stay, functional improvement potential)
  2. bChanges in Health, End-stage disease, Signs and Symptoms (CHESS) scale is a measure of instability in health; higher scores indicate greater instability
  3. cOther settings for transitions from nursing homes included discharges to other nursing homes, assisted living or retirement homes