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	Institution: CLOCKSS  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 3 No. 2, February 1994   Archives  • Online Features Original Contributions  This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (4)  • Contact me when this article is cited  Related Content  • Similar articles in this journal Prevalence of Advance Directives and Do-Not-Resuscitate Orders in Community Nursing Facilities Martha Terry; Steven Zweig, MD, MSPH Arch Fam Med. 1994;3(2):141-145. Abstract Objective To determine the prevalence of advance directives and do-not-resuscitate (DNR) orders in nursing homes and to measure the effect of the Patient Self-Determination Act (PSDA) and patient characteristics on these prevalences. Design Cross-sectional study. Setting Eight rural community nursing facilities. Participants Six hundred forty-one records of nursing home residents (total census of eight facilities). Results The mean age of the residents was 82.6 years and 75% were women. Thirty-seven percent were judged to have decisional capacity. Less than one third of the records revealed an advance directive (standard living will, 11.5%; other written directive, 11.1%; durable power of attorney for health care, 12%). Thirty-six percent had DNR orders. Residents with advance directives were older than those without them. Those residents with advance directives were more likely to have been admitted to the nursing home after the enactment of the PSDA (25.1% before vs 37.9% after enactment; P<.0001). There was substantial variation among facilities in both prevalences. Written rationales for DNR orders were found in only 40% of records. Conclusion Enactment of the PSDA reflects increased interest in documentation of advance directives. However, in many nursing facilities, the prevalence of advance directives and DNR orders is relatively low. A greater commitment will be required by providers, residents, and their proxies if we are to change this reality. Author Affiliations From the Washington University School of Medicine, St Louis, Mo (Ms Terry), and the Health of the Public Program and the Department of Family and Community Medicine, University of Missouri—Columbia (Dr Zweig). THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Use of Advance Directives for Nursing Home Residents in the Emergency Department Weinick et al. AM J HOSP PALLIAT CARE 2008;25:179-183. ABSTRACT   Differences in Presenting Advance Directives in the Chart, in the Minimum Data Set, and Through the Staffs Perceptions Cohen-Mansfield et al. The Gerontologist 2003;43:302-308. ABSTRACT | FULL TEXT   Increasing use of DNR orders in the elderly worldwide: whose choice is it? Cherniack J. Med. Ethics 2002;28:303-307. ABSTRACT | FULL TEXT   Implementation of Advance Directives Among Community-Dwelling Veterans Molloy et al. The Gerontologist 2000;40:213-217. ABSTRACT | FULL TEXT   Systematic Implementation of an Advance Directive Program in Nursing Homes: A Randomized Controlled Trial Molloy et al. JAMA 2000;283:1437-1444. ABSTRACT | FULL TEXT   Public Information and Private Search: Evaluating the Patient Self-Determination Act Bradley and Rizzo Journal of Health Politics, Policy and Law 1999;24:239-273. ABSTRACT   The Patient Self-Determination Act and Advance Directive Completion in Nursing Homes Bradley et al. Arch Fam Med 1998;7:417-423. ABSTRACT | FULL TEXT   Death and End-of-Life Planning in One Midwestern Community Hammes and Rooney Arch Intern Med 1998;158:383-390. ABSTRACT | FULL TEXT   Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders in the Nursing Home Zweig Arch Fam Med 1997;6:424-429. ABSTRACT   PREVALENCE OF ADVANCE DIRECTIVES REMAINS LOW IN NURSING HOMES JWatch General 1994;1994:6-6. FULL TEXT   HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP   © 1994 American Medical Association. All Rights Reserved.