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Acutely ill nursing home residents with advanced dementia are frequently transferred to acute-care hospitals. However, some people would argue that a palliative approach, without transfer to the hospital, is appropriate for many such patients.
Using a national dataset with information from most U.S. nursing homes, researchers examined the prevalence of do-not-hospitalize (DNH) orders among more than 91,000 nursing home residents aged 65 and older with advanced dementia (defined as “very severe impairment with eating problems”). Of these residents, 7.1% had DNH orders, with prevalences ranging from 1% in Oklahoma to 26% in Rhode Island. In multivariate analysis, the following characteristics were associated with increased likelihood of DNH or…