Advance directives in nursing homes: Resident and facility characteristics

Advance directives are a means whereby competent individuals can guide treatment decisions, and in many cases their death, at a future time when they may be rendered incompetent of doing so. This article first examines the differences between nursing home residents who choose to use advance directives and those that do not. Second, the differences between nursing homes who choose to use advance directives and those that do not are examined. Also, advance directives are not investigated as homogeneous constructs, rather they are divided into residents with a do-no-tresuscitate (DNR) status and those with other advance directives (i.e., do-not-hospitalize, living wills, and feeding restrictions). A multinomial logistic regression model with data representing 60,366 nursing home residents in ten states is used. Thirteen factors are significantly associated with a DNR status, whereas eleven factors are significantly associated with other advance directives. In both cases these significant factors include both resident characteristics and characteristics of the nursing homes. These results extend the scope of both facility and resident characteristics as important covariates in studies of advance directives.