Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Jung-Yeon Choi,1 Sun-wook Kim,1 Sol-Ji Yoon,2 Min-gu Kang,1 Kwang-il Kim,1 Cheol-Ho Kim1 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea; 2Department of Internal Medicine, Kangwon National University Hospital Gangwon-Do 200-722, Repu...

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Autores principales:	Choi JY, Kim SW, Yoon SJ, Kang MG, Kim KI, Kim CH
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Decision Making End of life Care Frailty Index Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/731cf4f827884d689fe45a5db3e61a08
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spelling	oai:doaj.org-article:731cf4f827884d689fe45a5db3e61a082021-12-02T11:06:57ZImpact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia1178-1998https://doaj.org/article/731cf4f827884d689fe45a5db3e61a082018-11-01T00:00:00Zhttps://www.dovepress.com/impact-of-frailty-on-do-not-resuscitate-orders-and-healthcare-transiti-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Jung-Yeon Choi,1 Sun-wook Kim,1 Sol-Ji Yoon,2 Min-gu Kang,1 Kwang-il Kim,1 Cheol-Ho Kim1 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea; 2Department of Internal Medicine, Kangwon National University Hospital Gangwon-Do 200-722, Republic of Korea Purpose: Pneumonia poses a significant health risk in aging societies. We aimed to elucidate the determinative value of frailty for do-not-resuscitate (DNR) orders in pneumonia patients. Patients and methods: This was a retrospective cohort study conducted at the Seoul National University Bundang Hospital (SNUBH) in Korea. Medical records of 431 pneumonia patients, aged 65 years and older, who were admitted between June 2014 and May 2015 were analyzed. Patients were categorized into DNR and no-DNR groups. Results: Among the 65 patients (15.1% of pneumonia patients) who completed DNR documents, 24 patients were survived, and 21 patients decided imminent to death (<24 hours before death), with all decisions determined by surrogates. The DNR group tended to be older and frail, with higher rates of renal impairment and malnutrition, and had a lower microbiology detection effort than the no-DNR group. The DNR group used a high number of broad-spectrum antibiotics, experienced high levels of in-hospital (63.1% vs 5.7%, P<0.001) and 30-day (64.6% vs 9.6%, P<0.001) mortality rates, and had prolonged hospital stays (median length of hospital stay, 12 vs 9 days, P=0.020). Frailty was independently associated with DNR status even after adjustment for sepsis, septic shock, and the pneumonia severity index (PSI) score. Frailty also significantly influenced healthcare setting transitions after adjustment for sepsis, septic shock, and the PSI. Conclusion: We identified the factors associated with DNR orders and their prognoses among elderly Koreans with pneumonia. Frailty was significantly associated with DNR decision and healthcare setting transitions in pneumonia patients. Keywords: do-not-resuscitate, end-of-life care, frailty indexChoi JYKim SWYoon SJKang MGKim KIKim CHDove Medical PressarticleDecision MakingEnd of life CareFrailty IndexGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 13, Pp 2237-2245 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Decision Making End of life Care Frailty Index Geriatrics RC952-954.6
spellingShingle	Decision Making End of life Care Frailty Index Geriatrics RC952-954.6 Choi JY Kim SW Yoon SJ Kang MG Kim KI Kim CH Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia
description	Jung-Yeon Choi,1 Sun-wook Kim,1 Sol-Ji Yoon,2 Min-gu Kang,1 Kwang-il Kim,1 Cheol-Ho Kim1 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea; 2Department of Internal Medicine, Kangwon National University Hospital Gangwon-Do 200-722, Republic of Korea Purpose: Pneumonia poses a significant health risk in aging societies. We aimed to elucidate the determinative value of frailty for do-not-resuscitate (DNR) orders in pneumonia patients. Patients and methods: This was a retrospective cohort study conducted at the Seoul National University Bundang Hospital (SNUBH) in Korea. Medical records of 431 pneumonia patients, aged 65 years and older, who were admitted between June 2014 and May 2015 were analyzed. Patients were categorized into DNR and no-DNR groups. Results: Among the 65 patients (15.1% of pneumonia patients) who completed DNR documents, 24 patients were survived, and 21 patients decided imminent to death (<24 hours before death), with all decisions determined by surrogates. The DNR group tended to be older and frail, with higher rates of renal impairment and malnutrition, and had a lower microbiology detection effort than the no-DNR group. The DNR group used a high number of broad-spectrum antibiotics, experienced high levels of in-hospital (63.1% vs 5.7%, P<0.001) and 30-day (64.6% vs 9.6%, P<0.001) mortality rates, and had prolonged hospital stays (median length of hospital stay, 12 vs 9 days, P=0.020). Frailty was independently associated with DNR status even after adjustment for sepsis, septic shock, and the pneumonia severity index (PSI) score. Frailty also significantly influenced healthcare setting transitions after adjustment for sepsis, septic shock, and the PSI. Conclusion: We identified the factors associated with DNR orders and their prognoses among elderly Koreans with pneumonia. Frailty was significantly associated with DNR decision and healthcare setting transitions in pneumonia patients. Keywords: do-not-resuscitate, end-of-life care, frailty index
format	article
author	Choi JY Kim SW Yoon SJ Kang MG Kim KI Kim CH
author_facet	Choi JY Kim SW Yoon SJ Kang MG Kim KI Kim CH
author_sort	Choi JY
title	Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia
title_short	Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia
title_full	Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia
title_fullStr	Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia
title_full_unstemmed	Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia
title_sort	impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly koreans with pneumonia
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/731cf4f827884d689fe45a5db3e61a08
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Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

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