UTILIZATION OF CARDIOPULMONARY-RESUSCITATION IN NURSING-HOMES IN ONE COMMUNITY - RATES AND NURSING-HOME CHARACTERISTICS

Objective: To determine the rate of cardiopulmonary resuscitation use among all nursing homes in a large urban area, to examine CPR use over time, to discover whether CPR use varies among nursing homes, and to describe characteristics of patients undergoing CPR. Design: Retrospective survey. Setting: Nursing homes in a large urban area. Participants: One hundred ninety-six nursing home residents of 68 nursing homes underwent cardiopulmonary resuscitation over a 4-year period (1986-1989). Over this time there were 9,486 deaths in these homes, which comprised 10,252 beds. Measurements: The CPR:death ratio was determined for each facility. The ratio was analyzed over time and by type of facility (eg, proprietary, non-profit, size of facility). The ratio was also examined among facilities with variable death rates. Patients undergoing CPR are described. Results: The ratio of CPR:death over the 4-year period was 0.02. CPR:death ratio was higher (0.03) for the proprietary homes compared with the non-profit homes (0.01) P < 0.0001. A significant downward trend of CPR:death was noted over the study period for the non-profit homes; no such trend was noted in the proprietary homes. Size of nursing home did not influence the rate of CPR use. Homes with greater numbers of deaths per bed had a lower utilization of CPR. Patients undergoing CPR were old, frail, and had multiple medical problems. CPR attempts were frequent around the time of nursing home admission. Conclusion: The utilization of CPR in nursing homes is quite low. Non-profit homes utilize CPR less than proprietary homes. Nursing homes with the highest numbers of deaths per bed utilize CPR less than homes with lower numbers of deaths per bed. Nursing home residents receiving CPR are quite old, have multiple illnesses, and are impaired.