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Advance Directives Less Likely for Mentally Ill Residents

Lower rates of medical advance care plans in nursing home residents with serious mental illness

WEDNESDAY, Jan. 12 (HealthDay News) -- Among residents of U.S. nursing homes, those with serious mental illness are less likely to have written medical advance directives, according to research published in the January issue of Psychiatric Services.

Xueya Cai, Ph.D., of the University of Iowa in Iowa City, and colleagues analyzed data from the 2004 National Nursing Home Survey of 1,769 nursing home residents with serious mental illness and 11,738 without, from 1,174 nursing homes. They also conducted personal interviews with facility administrators and staff to obtain data about residents.

The researchers found 57 and 68 percent of residents with and without serious mental illness, respectively, had 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. Those with serious mental illness had lower rates of individual advance care plans as well. Adjusting for resident and facility characteristics and survey procedures, multivariate analysis showed that serious mental illness was associated with 24 percent reduced odds of having any advance directives, similar to the results for individual documented plans.

"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," the authors write.

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