Failure to Give Physician Treatment Orders to Nursing Home Patients Can Diminish End-of-Life Care

Older adult patients residing in nursing homes are often vulnerable and have limited life expectancy. As a result, critical thinking of desirability of future medical interventions is crucial. Advanced care planning (ACP) is often encouraged as a way to make decisions about future medical care. ACP calls for the continuous process of the patient and care provider making joint decisions about future medical care, in the event the patient is not able to consent to or refuses to receive treatment or other care. Several studies have shown ACP to have beneficial effects on end-of-life care, with a decrease in hospitalizations, enhanced patient and family satisfactions, greater concordance between patient’s past preferences and treatments received, and a decrease in distress of kin. The primary goal of ACP is to adapt medical care to the preferences and life goals of the patient.

Because it is common for older adults to have no documented ACP prior to nursing home admission, elderly care physicians initiate ACP discussions with their patients or their family caregivers in case of incapacity. The results of these conversations are documented in the patients’ medical records, also known as physician treatment orders (PTO).

A recent study aimed to analyze the degree of PTO implementation in the everyday clinical practice of long-term care facilities. The results of the study showed that most patients admitted to Dutch nursing homes were given initial PTOs pertaining to life-sustaining or palliative medical treatment and PTOs pertaining to resuscitation or withholding of resuscitation within 6 weeks after admission. However, researchers found that a significant minority had no documentation of PTOs. Patients without a PTO were generally younger, commonly married, and admitted to a rehabilitation ward. The relatively short duration of stay of patients admitted to a rehabilitation ward might have caused fewer opportunities for older adult care physicians to implement advanced treatment discussions and document PTOs of their patients.

The failure to provide PTOs during nursing home patients’ stay may negatively impact end-of-life care. Health care professionals working with these long-term care patients must be thorough when providing care to their patients so that the quality of life of these vulnerable individuals can improve.