Journal of the American Geriatrics Society
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Do-not-resuscitate (DNR) orders have become an accepted part of medical practice. While these orders have been extensively evaluated in acute care hospitals, little is known about their use in the long-term care setting. We reviewed the medical records of all admissions to a chronic care hospital over a 13-month period, collecting data on selected patient characteristics, use of DNR orders, and patient outcomes during the 6-week period following admission. ⋯ They were no more likely to be transferred emergently to an acute care hospital (5% vs 9%, P greater than 0.2). We conclude that DNR orders are not infrequently used, and physicians rarely make the decision unilaterally. Patients with DNR orders have a high likelihood of dying and are infrequently transferred to acute care facilities.
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Case Reports Guideline
Decision making in the incompetent elderly: "The Daughter from California syndrome".
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Nursing home residents are frequently transferred to hospital emergency departments. Delayed transfer may lead to poor outcomes. However, inappropriate transfer of the frail elderly may cause social and financial problems. ⋯ The results indicate that the problems of nearly half the study group could have been treated at the nursing home by a visiting physician with minimal medical equipment. Those admitted to the hospital (52%) were seriously ill, had prolonged lengths of stay (23.6 days), and had a high mortality rate (11%). Complex issues of physician reimbursement, proprietary nursing home budgeting, and day-to-day expediency appear to be involved in decisions to transport patients by ambulance to VA emergency departments.
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Comparative Study
Subcutaneous fluid administration in elderly subjects: validation of an under-used technique.
In a crossover study in six volunteers over the age of 65, absorption of 500 mL of normal saline given subcutaneously was compared with that given intravenously. Tritiated water and technetium pertechnetate were used as water tracers. ⋯ Radioactivity could not be demonstrated at the subcutaneous site 1 hour after completion of the infusion. Subcutaneous infusion is an effective method of giving fluid to elderly people and deserves more widespread use.