As people grow old, and this is particularly true for people with chronic conditions, hospitalizations become more frequent.
But experts say that in many cases, hospitalization is not actually helpful. Rather, it stresses the patient and exposes them to more tests and procedures. They might live a bit longer, but the quality of that life can be poor.
Because of this unpleasantness, more people, especially those living in nursing homes, are looking to reduce hospitalizations through their advanced care planning with Do Not Hospitalize orders. The order may not be an absolute direction, but it’s typically intended to reduce incidents of hospitalization rather than ban them outright. Exceptions can also be written into the order – say for severe pain or excessive bleeding.
It’s imperative that the elderly have these conversations in advance, while they are still competent to make decisions about their own healthcare. For patients with progressive and debilitating conditions like Alzheimer’s, it’s possible for them to make decisions in advance, while they are still in possession of their faculties.
While these instructions could be provided in a living will or advance directive, research has found that this approach could be less effective than having an updated DNH order. Moreover, it’s important to be specific when stating preferences for care, as in the case of ambiguity medical professionals tend to fall back on the default position of hospitalization.
Despite the patient’s wishes, there may be cases in which the DNH is not appropriate, particularly for nursing home residents. Sometimes, the hospital is the best place to treat a particular condition. Moreover, not all nursing homes may be equipped for optimal pain management.
Families must be proactive in initiating the sometimes painful conversations that are necessary to understand an elderly relative’s wishes and ensure that they are cared for in a manner consistent with their values.
For more information, please read:
A Lesser Known Advanced Directive: ‘Do-Not-Hospitalize’ | US News