Advance Directives Preferences of Functionally and Cognitively Impaired Nursing Home Residents in the United States

Abstract

This study analyzed advance directives preferences of nursing home residents by level and type of impairment (cognitive and functional). There is a great need to improve care of nursing home residents by honoring their advance directives and reducing the number of adverse events. This secondary data analysis included a random sample of 3,747 subjects from the national Medical Expenditure Panel Survey-Nursing Home Component (MEPS-NHC) Round 1 database. Cognitive and/or functionally impaired residents were more likely to have urinary tract infections, pneumonia, and tuberculosis. Logistic regression models identified several factors (noted in parentheses) that were significantly associated with four advance directives preferences: (a) living will (age, educational level, marital status, and the interaction of functional and cognitive impairment), (b) do not resuscitate (DNR) (age, educational level, marital status, and the interaction of functional and cognitive impairment), (c) no hospitalization (age, educational level, and the interaction of functional and cognitive impairment), and (d) no medications and treatments (educational level).