Predicting future functional status for seriously ill hospitalized adults

Article Abstract:

Certain clinical information may be of value in predicting the functional status of adult patients following hospitalization with serious illness. A study of 1746 patients who survived two months after hospitalization with one of nine serious illnesses found that one-third had severe functional limitations following their hospitalization, and another one-third were better after their illness than they were before. A person's functional status two weeks before hospitalization may be the main predictor of serious functional limitations two months after hospitalization. Other predictive influences include the nature of the illness, how severely the illness affected the body, the patient's quality of life and capacity for physical activity, the length of hospitalization before study entry, and age for patients over 60. Predictions of functional limitations following illness and hospitalization may be used to plan for support services or to evaluate treatment options in light of the outcomes they may create.

Research, Forecasts and trends, Hospital patients, Prognosis

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Perceptions by family members of the dying experience of older and seriously ill patients

Article Abstract:

It appears that despite expressed wishes to the contrary many patients die in pain or while receiving unwanted life-support measures. Medical records from the last days of life of 408 elderly patients and 4214 seriously ill patients were reviewed and 3357 family members were interviewed. Fifty-nine percent of the patients expressed a desire to die comfortably. However, one in ten patients were not given this type of care and 55% of all patients spent the last three days of their life conscious and in pain. Doctors attempted life-support measures on 56% of the patients during the last three days of life.

Assisted suicide, Ethical aspects, Right to refuse treatment, Treatment refusal

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Factors associated with do-not-resuscitate orders: patients' preferences, prognoses, and physicians' judgments

Article Abstract:

Do-not-resuscitate (DNR) orders for seriously ill patients may not reflect patients' preferences or expected medical outcomes. A DNR order instructs hospital staff not to resuscitate in the event of cardiac or respiratory failure. Among 6,802 seriously ill patients in 5 hospitals, the use and timing of DNR orders varied greatly according to health specialty and hospital. Only 52% of patients who did not want to be resuscitated actually had orders written. Physicians may be using age as a criterion for DNR orders rather than considering the relationship between age, survival and probable outcome.

Decision making, Analysis, Planning, Decision-making (Ethics), Cardiac resuscitation

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