Nursing Home Resident Use

inform all residents upon admission of their rights to enact care directives in the event of terminal illness. This study investi-gated the relationship between care directive use and resident functional status. Methods. We analyzed a version of the Minimum Data Set (MDS+) from a single state. We selected residents who were ad-mitted to a nursing home in the first half of 1993 and followed them in the nursing home through the end of 1994. We created logistic models to examine independent correlates associated with having an advance directive or a do-not-resuscitate (DNR) order on admission. We then created similar logistic models to examine independent correlates associated with writing an ad-vance directive or DNR order subsequent to admission. Results. Of the 2,780 residents, 11 % (292) had advance directives and 17 % (466) had DNR orders upon admission. Of those without care directives upon admission, 6 % (143) subsequently had an advance directive and 15 % (339) subsequently had a DNR order. Cross-sectionally, older individuals and whites were more likely to have a care directive. Having poor cogni-tive and physical function was associated with having a DNR order upon admission. Longitudinally, longer stayers and whites were more likely to have an advance directive. Residents who lost physical function were more likely to have an advance direc-tive and those who lost cognitive function were more likely to have a DNR order. Conclusions. Care directive use is influenced by a number of sociodemographic and functional characteristics. CARE directives are widely recognized as a means of pre-serving patient autonomy after the loss of decision-mak