• Cheryl A Monturo and Neville E Strumpf.
• West Chester University College of Health Sciences, Department of Nursing, West Chester, PA 19383, USA. cmonturo@wcupa.edu
• J Am Med Dir Assoc. 2007 May 1;8(4):224-8.

ObjectiveNursing homes are increasingly the place where many Americans die. Thus, advance directives are critical to the preservation of the autonomous wishes at end-of-life. The purpose of this paper is to determine if preferences for artificial nutrition, as stated in the advance directives of nursing home residents, are honored in the last 2 months of life.DesignSecondary analysis.SettingSix Maryland community nursing homes.ParticipantsFifty-seven consented residents (age 62 to 98) from the parent study who died during the study period.MeasurementsRetrospective document review including advance directives and clinical care provided in the last 2 months of life.ResultsMost of the nursing home residents in this sample refused feeding tubes, and these preferences were honored during the last 2 months of life (93%), despite some (17% to 26%) with documented weight loss. A small percentage (8.8%) of residents received feeding tubes at end-of-life and, of those, only 1 was consistent with advance directive preferences. Most advance directives in this study included feeding tube preferences.ConclusionIn this nursing home sample, advance directives were significant documents guiding decisions on artificial nutrition, and feeding tubes were in fact uncommon at the end of life. The study suggests that advance care planning, quality palliative care training, and administrative support are necessary for the honoring of preferences. Future research is needed to examine more broadly tube-feeding practices and prevalence in nursing homes.

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