{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Mehta AB"],"funding":["NCATS NIH HHS","NHLBI NIH HHS","NINR NIH HHS"],"pagination":["201-208"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC10908317"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["27(2)"],"pubmed_abstract":["<b><i>Background:</i></b> Reports of poor outcomes among older adults with COVID-19 may have changed patient perceptions of Do-Not-Resuscitate (DNR) orders or caused providers to pressure older adults into accepting DNR orders to conserve resources. <b><i>Objective:</i></b> We determined early-DNR utilization during COVID-19 surges compared with nonsurge periods among nonsurgical adults ≥75 and its connection to hospital mortality. <b><i>Methods:</i></b> We conducted a retrospective cohort study among adults ≥75 years using the California Patient Discharge Database 2020. The primary outcome was early-DNR utilization. Control cohorts included nonsurgical adults <75 years in 2020 and nonsurgical adults ≥75 in 2019. Multiple causal inference methods were used to address measured and unmeasured confounding. <b><i>Results:</i></b> A total of 487,955 adults ≥75 years were identified, with 233,678 admitted during COVID-19 surges. Older adults admitted during surges had higher rates of early-DNR orders (30.1% vs. 29.4%, absolute risk differences = 0.7, 95% confidence interval [CI]: 0.5-1.0) even after adjusting for patient case-mix (adjusted odds ratio [aOR] = 1.02, 95% CI: 1.01-1.04). Patients with early-DNR orders experienced higher hospital mortality (15.5% vs. 4.8%, aOR = 3.96, 95% CI: 3.85-4.06). Difference-in-difference analyses demonstrated that adults <75 years in 2020 and adults ≥75 years in 2019 did not experience variation in early-DNR utilization. <b><i>Conclusions:</i></b> Older adults had slightly higher rates of early-DNR orders during COVID-19 surges compared with nonsurge periods. While the difference in early-DNR utilization was small, it was linked to higher odds of death. The increase in early-DNR use only during COVID-19 surges and only among older adults may reflect changes in patient preferences or increased pressure on older adults stemming from provider fears of rationing during COVID-19 surges."],"journal":["Journal of palliative medicine"],"pubmed_title":["Utilization of Hospital Do-Not-Resuscitate Orders in Older Adults During COVID-19 Surges in 2020."],"pmcid":["PMC10908317"],"funding_grant_id":["K23 HL141704","R01 NR016459","UL1 TR002535"],"pubmed_authors":["Mehta AB","Battaglia C","Douglas IS","Wynia MK"],"additional_accession":[]},"is_claimable":false,"name":"Utilization of Hospital Do-Not-Resuscitate Orders in Older Adults During COVID-19 Surges in 2020.","description":"<b><i>Background:</i></b> Reports of poor outcomes among older adults with COVID-19 may have changed patient perceptions of Do-Not-Resuscitate (DNR) orders or caused providers to pressure older adults into accepting DNR orders to conserve resources. <b><i>Objective:</i></b> We determined early-DNR utilization during COVID-19 surges compared with nonsurge periods among nonsurgical adults ≥75 and its connection to hospital mortality. <b><i>Methods:</i></b> We conducted a retrospective cohort study among adults ≥75 years using the California Patient Discharge Database 2020. The primary outcome was early-DNR utilization. Control cohorts included nonsurgical adults <75 years in 2020 and nonsurgical adults ≥75 in 2019. Multiple causal inference methods were used to address measured and unmeasured confounding. <b><i>Results:</i></b> A total of 487,955 adults ≥75 years were identified, with 233,678 admitted during COVID-19 surges. Older adults admitted during surges had higher rates of early-DNR orders (30.1% vs. 29.4%, absolute risk differences = 0.7, 95% confidence interval [CI]: 0.5-1.0) even after adjusting for patient case-mix (adjusted odds ratio [aOR] = 1.02, 95% CI: 1.01-1.04). Patients with early-DNR orders experienced higher hospital mortality (15.5% vs. 4.8%, aOR = 3.96, 95% CI: 3.85-4.06). Difference-in-difference analyses demonstrated that adults <75 years in 2020 and adults ≥75 years in 2019 did not experience variation in early-DNR utilization. <b><i>Conclusions:</i></b> Older adults had slightly higher rates of early-DNR orders during COVID-19 surges compared with nonsurge periods. While the difference in early-DNR utilization was small, it was linked to higher odds of death. The increase in early-DNR use only during COVID-19 surges and only among older adults may reflect changes in patient preferences or increased pressure on older adults stemming from provider fears of rationing during COVID-19 surges.","dates":{"release":"2024-01-01T00:00:00Z","publication":"2024 Feb","modification":"2025-04-03T23:22:23.647Z","creation":"2025-04-03T23:22:23.647Z"},"accession":"S-EPMC10908317","cross_references":{"pubmed":["37616551"],"doi":["10.1089/jpm.2023.0277"]}}