Abstract
BackgroundMany of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient’s best interest, assessment of capacity to consent, and on the patient’s own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards.MethodsUsing a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital.ResultsThe patients’ capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p < 0.001). The answers indicate that capacity to consent can be difficult to assess. Patients that were considered capable to consent, were more often involved in the decision-making in nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself.ConclusionsThis study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better.Trial registrationClinicalTrials.gov NCT01023763 (12/1/09) [The registration was delayed one month after study onset due to practical reasons].
Highlights
Many of the elderly in nursing homes are very ill and have a reduced quality of life
Seven of the nursing homes had nursing home doctors employed in full time or half time positions; 21 used general practitioners (GPs) working 20% in the nursing homes; two of the large nursing homes had a combination of the two
We present the results of the questionnaire about the decision-making process, filled out for 299 (91%) of the patients: 24 (22%) of the patients who were treated in the hospital, and 7 (3%) of those treated in the nursing home were excluded from the analysis due to incomplete answers
Summary
Many of the elderly in nursing homes are very ill and have a reduced quality of life. Decisions about life-prolonging treatment should be based on a professional assessment of the patient’s best interest, assessment of capacity to consent, and on the patient’s own wishes. Decisions about life-prolonging treatment should be based on a clinical evaluation of the patient’s best interest – and on the patient’s own wishes [1]. A permanent resident in a Norwegian nursing home lives there for an average of 1.5–2 years before they die, but there are large variations [4]. Life-prolonging treatment is defined as all treatment and interventions that can delay a patient’s death [1]. Examples of this in nursing homes are intravenous fluids and antibiotic treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
