ABSTRACT: ObjectivesTo look for predictors in the clinical records of orders for “limitation of life sustaining treatment” (LLST) or “do not attempt
resuscitation” (DNAR) in hospitalized elders and to assess the relationship between the presence of these orders and the quality
of end-of-life (EOL) care.
DesignRetrospective clinical record review.
SettingInpatients of an inner city elderly acute care unit (EACU) in Spain.
ParticipantsOf 103 hospitalized patients who died in the EACU during one year, 90 dying an expected death either from acute or chronic
disease were included.
MeasurementsDemographic, functional, cognitive, clinical, and end-of-life (EOL) parameters. The influence of identifying closeness to
death and the number of LLST suborders on the quality of EOL-management were considered simultaneously using structural equation
modelling with LISREL 8.30 software.
ResultsLLST and specific DNAR orders were registered in 91.1% and 83.3% of patients, respectively. Failure of acute treatment, discussions
with the patient/family, recognizing the presence of common EOL symptoms, and prescribing specific symptomatic treatment were
recorded in 88.9%, 93.3%, 94.4%, and 86.7% of patients, respectively. LLST-orders were more likely to be documented if there
was severe functional impairment prior to admission (p<0.001), advanced organ disease criteria were met (p=0.006), or closeness
to death was acknowledged in writing (p<0.001). The quality of the EOL-management was better in patients for whom there were
LLST-orders (p =0.01) and written acknowledgement of closeness to death (p<0.001).
ConclusionsLLST-orders were more likely to be written in an EACU for patients with previous severe impairment, co-morbidity, or advanced
disease. Written acknowledgement of closeness to death and LLST-orders were predictors of better EOL-management.
The Journal of Nutrition Health and Aging 04/2012; 13(7):644-650. · 2.69 Impact Factor