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Prevalence of Patients With Do-Not-Resuscitate Status on Acute Geriatric Wards in Flanders, Belgium

¹ End-of-Life Care Research Group, Vrije Universiteit Brussel, Belgium.
² Centre for Environmental Philosophy and Bioethics, Ghent University, Belgium.
³ Department of Geriatrics, Ghent University Hospital, Belgium.
⁴ Department of Geriatrics, Academic Hospital Vrije Universiteit Brussel, Belgium.
⁵ Heymans Institute of Pharmacology, Ghent University, Belgium.
⁶ Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.

Address correspondence to Cindy De Gendt, MSc, End-of-Life Care Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium. E-mail: cindy.de.gendt{at}vub.ac.be

Background. Elderly hospitalized patients have low survival rates after cardiopulmonary resuscitation, especially in the long term. This study aims to investigate the prevalence of patients with do-not-resuscitate (DNR) status on acute geriatric wards and the characteristics of the preceding decision-making process.

Methods. On all 94 geriatric wards in Flanders, Belgium (2002), the geriatrician who performed the bulk of clinical work was asked to fill in a retrospective structured mail questionnaire.

Results. The response rate was 72.3%. A DNR status was attributed to 20.3% of patients. A significant higher prevalence of patients with DNR status was found on wards with a geriatrician who had been active in patient care for 15 years or less and on wards with a DNR policy. Mostly, DNR status was attributed when the patient's condition declined (34.0%) or became critical (29.0%). Geriatricians consulted at least one person in 81.0% of the cases: (head) nurses in 72.2%, next of kin in 61.9%, the patient's general practitioner in 22.6%, and the patient him- or herself in 15.7%. Reasons stated to make a DNR decision were the prognosis (68.1%) and the physical condition of the patient (62.2%). Age was mentioned in only 21.1% of the cases, always in combination with other reasons.

Conclusions. One fifth of patients on acute geriatric wards in Flanders have DNR status. The decision to attribute DNR status is most often made late in the course of the disease. (Head) nurses and the patient's next of kin are often consulted, the patient and his or her general practitioner rarely.

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