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© 1996 Oxford University Press

research-article

Dementia in Resuscitation Policy: A Prospective Study on a Psychogeriatric Ward in a Dutch General Teaching Hospital

P. L. J. DAUTZENBERG, C. HOOYER, R. S. SCHONWETTER, K. M. T. DERMOUT, J. K. VD VEER and S. A. DUURSMA

Department of Geriatrics Bosch Medicentrum Box 90152, 5200 MD s'Hertogenbosch
Department of Psychiatry, Free University of Amsterdam The Netherlands
Division of Geriatrics, Department of Internal Medicine, University of South Florida USA
Department of Psychiatry, Reiner van Arkel Hospital, Vught The Netherlands
Division of Psychiatry, Department of Geriatrics, Slotervaart Hospital Amsterdam, The Netherlands
Department of Geriatrics, Utrecht University Hospital The Netherlands

Resuscitation decisions during the first 6 weeks were analysed for 97 admissions to a psychogeriatric ward of a general teaching hospital. Seventy-seven patients (79%) had a written ‘do not resuscitate’ (DNR) order on admission and 74 patients (87%) had a written DNR order after 6 weeks. Morbidity was assessed with a pre-arrest morbidity (PAM) index and a modified PAM index (MPI).

Dementia influenced the presence of a DNR order, both because lack of effectiveness of CPR and lack of quality of life. Age was related to a DNR order. The MPI was associated with the presence of a written DNR order, while the PAM score failed to reach significance. Six weeks after admission DNR orders were predictable by the four variables dementia, the use of antidepressants, age and PAM, in that order.

The association of the use of antidepressants with the presence of a written DNR order was surprising. The use of antidepressants is not the same as the diagnosis of depression. Because of the design, our results cannot permit any conclusion whether depression acts as an additional factor considered in decision-making in psychogeriatric patients. We suggest that depression and its correlates should be considered in discussions and studies about DNR.

Revision received October 27, 1995.
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