Presentation (CTI)

OBJECTIVES: While Do-Not-Attempt to Resuscitate (DNAR) orders are commonly issued for critically ill patients, they are also used in non-critical inpatients as routine practice, often to reassure staff or avoid confusion during sudden deterioration, especially in the extremely elderly. However, little is known about the characteristics of such patients. This study aims to describe the clinical characteristics, in terms of DNAR order, of patients aged ≥85 who were admitted for non-critical conditions to a Japanese university hospital.
METHODS: Using electronic medical record data, we described the clinical characteristics of patients aged ≥85 years who were admitted to Fukushima Medical University Hospital between 2022 and 2024, excluding those admitted to the emergency department and intensive care unit, by comparing those with and without DNAR orders.
RESULTS: Among 1,438 inpatients aged ≥85 years (mean age 88.1, SD 3.2; 50.7% male), 201 (14.0%) had DNAR orders. Their mean age was 89.6 (SD 4.0), compared to 87.9 (SD 2.9) in the non-DNAR group. In the DNAR group, 66.2% had the order placed within 3 days of admission. Based on the Katz Index, the index of activities of daily living (ADL), 13.4% of the DNAR group were fully independent (score 6), while 54.7% were fully dependent (score 0); the corresponding proportions in the non-DNAR group were 50.1% and 15.3%, respectively. Common admission diagnoses in the DNAR group included COVID-19 (17.4%) and congestive heart failure (10.0%). Frequent comorbidities were diabetes (9.5%), chronic kidney disease (6.0%), chronic heart failure (6.0%), advanced cancer (5.0%), dementia (3.0%), and COPD (3.0%). In-hospital mortality was 19.9% in the DNAR group versus 2.2% in the non-DNAR group. Transfers to long-term care hospitals occurred in 45.8% and 16.2%, respectively.
CONCLUSIONS: DNAR orders were uncommon but associated with lower ADL, higher in-hospital mortality, and more frequent transfers to long-term care facilities.