Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness

Abstract

Objective Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans. Methods Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with serious mental illness (N=1,769) and without (N=11,738). Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; “do not resuscitate” and “do not hospitalize” orders; and orders concerning restriction of feeding tube, medication, or other treatments. Results The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66–.87, p<.001). Similar results were found for individual documented plans. Conclusions Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding.

A scoping review of palliative care for persons with severe persistent mental illness

“…People with SPMI at end-of-life are often transferred between settings and may be underserved (such as having psychiatric medications discontinued) when they are admitted to acute care (Jerwood et al, 2018; Morgan, 2016; Terpstra et al, 2014). Settings unable to meet the needs of those with SPMI may result in transfer or discharge to equally inappropriate settings, such as nursing homes ill-equipped to provide palliative care for patients with schizophrenia and other SPMIs (Cai et al, 2011; Chochinov et al, 2012; Lavin et al, 2017; Jerwood et al, 2018; Martens et al, 2013). Relatedly, people with SPMI may not have access to the care they need because of the potential loss of information between service providers and settings (Davie, 2006; Terpstra et al, 2014).…”

End-of-Life Care in Individuals With Serious Mental Illness

“…31 Likewise, in nursing home settings, SMI was associated with a lower rate of advance care planning. 32 In part, this may be due to a dearth of validated tools to enhance palliative care for individuals with SMI. 22…”

End-of-Life Care for Patients with Schizophrenia #332

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