Article Figures & Data
Tables
DEGREES OF INTERVENTION EXPLANATION “Do not hospitalize” designation • 1 Supportive care—such as nursing care, relief of pain, control of fever, administration of oral fluids or intermittent oxygen, and continued management of standing chronic conditions—within the facility
No transfer to hospital unless adequate comfort measures cannot be provided at the facility
No CPR• 2 Degree 1 plus therapeutic measures and medications to manage acute conditions within the limits of the facility
No transfer to hospital unless adequate comfort measures cannot be provided at the facility
No CPR“Hospitalize” designation • 3 Degree 2 plus admission to an acute care hospital for medical or surgical treatment as indicated
No referral to intensive care
No CPR• 4 Maximum therapeutic effort (as degree 3) including referral to intensive care and use of CPR if indicated -
CPR—cardiopulmonary resuscitation.
-
CHARACTERISTICS* TOTAL Demographic • Female sex, n/N (%) 265/369 (72) • Married and partner alive, n/N (%) 139/369 (38) Clinical and functional • Median (IQR) no. of Charlson comorbidities† 3.0 (2.0) • Sudden and unexpected death, n/N (%) 32/369 (9) • Median (IQR) no. of medications 4.0 (4.0) • Median (IQR) no. of debilities‡ 2.0 (2.0) Use of health services • Visited the hospital ED in the 3 months before death, n/N (%) 103/368 (28) • Median (IQR) no. of hospital ED visits in the 3 months before death 0.0 (1.0) • Hospital admission in the 3 months before death, n/N (%) 96/369 (26) • Death in facility (vs hospital), n/N (%) 341/369 (92) • Median (IQR) no. of visits by family physician in the 3 months before death 4.0 (5.0) • Continuity of family physician from admission to death, n/N (%) 287/369 (78) • Median (IQR) length of stay (in weeks) from admission to extended care until death§ 56.1 (125.3) • Median (IQR) no. of weeks “at risk” of “do not hospitalize” designation from admission to extended care|| 2.0 (53.0) • Proportion of residents with “do not hospitalize” designation at time of death, n/N (%) 321/367 (87) -
SD—standard deviation, ED—emergency department, IQR—interquartile range.
-
↵* Characteristics measured at time of death unless stated otherwise.
-
↵† Sum of coronary artery disease, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, connective tissue disease, ulcer disease or gastrointestinal bleed, liver disease, diabetes, hemiplegia or hemiparesis, renal disease, cancer, metastatic cancer, and AIDS.
-
↵‡ Sum of presence of pressure ulcers, indwelling bladder catheter, wheelchair dependency, dependence on others for feeding, and requiring a mechanical lift for transfers.
-
↵§ Residents of free-standing facilities might have entered the facilities as intermediate care residents, and entrance to extended care might have occurred at a later date.
-
↵|| The “at risk” period was the number of weeks each resident had a “hospitalize” designation from the time of admission into extended care until death or a change to “do not hospitalize.”
-
- Table 3
Univariable and multivariable regression analyses of factors associated with “do not hospitalize” designations among residents with “hospitalize” designations on admission to extended care (n = 227)
FACTORS* UNIVARIABLE HAZARD RATIO (95% CI) MULTIVARIABLE HAZARD RATIO (95% CI) Demographic • Age upon admission to extended care 1.02 (1.01–1.02)† 1.02 (1.01–1.02)† • Female sex 1.15 (1.05–1.25)† • Married and partner alive 1.31 (0.94–1.81) Clinical and functional • No. of Charlson comorbidities‡ 1.03 (0.96–1.11) • Sudden and unexpected death 0.44 (0.20–0.97)† 0.43 (0.25–0.73)† • No. of medications 1.01 (0.94–1.09) • No. of debilities§ 0.98 (0.89–1.08) • Ulcer or gastrointestinal bleed|| 0.81 (0.50–1.31) Use of health services • No. of ED visits in 3 months before death 0.85 (0.61–1.18) • No. of visits by family physician in 3 months before death 1.00 (0.99–1.01) 1.01 (1.00–1.03)† • Continuity of family physician from admission to death 2.19 (1.38–3.47)† 2.17 (1.33–3.49)† • Hospital-based facility 1.21 (1.01–1.45)† -
CI—confidence interval, ED—emergency department.
-
↵* Characteristics measured at time of death unless stated otherwise.
-
↵† Statistically significant at P ≤. 05.
-
↵‡ Sum of coronary artery disease, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, connective tissue disease, ulcer disease or gastrointestinal bleed, liver disease, diabetes, hemiplegia or hemiparesis, renal disease, cancer, metastatic cancer, and AIDS.
-
↵§ Sum of presence of pressure ulcers, indwelling bladder catheter, wheelchair dependency, dependence on others for feeding, and requiring a mechanical lift for transfers.
-
↵|| Ulcer or gastrointestinal bleed was the only Charlson comorbidity associated with the “do not hospitalize” designation at time of death in initial 2-way tests of comparison and therefore was included in Cox regression models.
-
