{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:24:43Z","timestamp":1777929883949,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliative Medicine Reports"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>During the coronavirus disease 2019 (COVID-19) pandemic, older adults experienced high mortality rates, and their deaths were often preceded by sudden health deterioration and acute respiratory failure. This prompted older adults and their families to make rapid goals-of-care decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This study aimed at determining the prevalence of and factors associated with COVID-19-related do-not-attempt resuscitation (DNR) decisions among older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This was a cross-sectional population-based survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Well-looking active (mobile) community-dwelling adults aged \u226560 years and residing in the Bangkok district, Thailand, between April and May 2020, were included in this study. We excluded older adults who (1) were unable to speak Thai, (2) had severe cognitive impairment, or (3) were blind or deaf. We interviewed participants about their perceptions regarding end-of-life decisions in case they got infected with COVID-19 and experienced respiratory arrest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We recruited 848 participants with a mean age of 70.5 (\u00b16.74) years. When asked about their choice, 49.8% chose a DNR status, 44.5% chose full life support, and 5.8% were undecided. The three most common reasons provided by the DNR group for their choice were old age (54.9%), acceptance of death (15.6%), and fear of pain (8.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Almost half of the older Thai adults chose a DNR status for scenarios in which they were infected with COVID-19 and suffered from cardiac arrest during the pandemic period. Future studies should include an in-depth examination of participants' lifestyles, family life expectancy, and religious faith to understand their end-of-life decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/pmr.2021.0084","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T09:47:20Z","timestamp":1655804840000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Perception of Older Thai Adults in a Do-Not-Attempt Resuscitation Order during the COVID-19 Era If Infected with COVID-19"],"prefix":"10.1177","volume":"3","author":[{"given":"Jiraporn","family":"Sri-on","sequence":"first","affiliation":[{"name":"Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pannawat","family":"Wongthanasit","sequence":"additional","affiliation":[{"name":"The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thitiwan","family":"Paksopis","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shan W.","family":"Liu","sequence":"additional","affiliation":[{"name":"The Department of Emergency Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khemika","family":"Rojtangkom","sequence":"additional","affiliation":[{"name":"The Clinical Research Center, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rasida","family":"Ruangsiri","sequence":"additional","affiliation":[{"name":"Thai Health Promotion Organization (ThaiHealth), Bangkok, Thailand."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/j.1475-6773.2004.00232.x","article-title":"Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life","volume":"39","author":"Barnato AE","unstructured":"Barnato AE, , Mcclellan MB, , Kagay CR, et al.: Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life. Health Serv Res 2004;39:363\u2013376.","journal-title":"Health Serv Res"},{"key":"e_1_3_6_3_2","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1001\/jamainternmed.2014.1179","article-title":"Use of mechanical ventilation by patients with and without dementia, 2001 through 2011","volume":"174","author":"Lagu T","unstructured":"Lagu T, , Zilberberg MD, , Tjia J, et al.: Use of mechanical ventilation by patients with and without dementia, 2001 through 2011. JAMA Intern Med 2014;174:999\u20131001.","journal-title":"JAMA Intern Med"},{"key":"e_1_3_6_4_2","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1089\/jpm.2018.0632","article-title":"A time-to-death analysis of older adults after emergency department intubation","volume":"23","author":"George N","unstructured":"George N, , Jambaulikar GD, , Sanders J, et al.: A time-to-death analysis of older adults after emergency department intubation. J Palliat Med 2020;23:401\u2013405.","journal-title":"J Palliat Med"},{"key":"e_1_3_6_5_2","first-page":"302","volume":"11","author":"Breault JL","unstructured":"Breault JL, : DNR DN, AR, or AND? Is language important?. Ochsner J 2011;11:302\u2013306.","journal-title":"Ochsner J"},{"key":"e_1_3_6_6_2","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.1001\/jama.284.19.2476","article-title":"Factors considered important at the end of life by patients, family, physicians, and other care providers","volume":"284","author":"Steinhauser KE","unstructured":"Steinhauser KE, , Christakis NA, , Clipp EC, et al.: Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 2000;284:2476\u20132482.","journal-title":"JAMA"},{"key":"e_1_3_6_7_2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ijsu.2020.02.034","article-title":"World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)","volume":"76","author":"Sohrabi C","unstructured":"Sohrabi C, , Alsafi Z, , O'Neill N, et al.: World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71\u201376.","journal-title":"Int J Surg"},{"key":"e_1_3_6_8_2","unstructured":"World Health Organization: WHO Coronavirus Disease (COVID-19) Dashboard 2021. https:\/\/covid19.who.int (Last accessed June24 2021)."},{"key":"e_1_3_6_9_2","unstructured":"Center for Disease Control and Prevention: COVID Data Tracker 2021. https:\/\/covid.cdc.gov\/covid-data-tracker\/#demographics (Last accessed June26 2021)."},{"key":"e_1_3_6_10_2","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1111\/jgs.16472","article-title":"COVID-19 and older adults: What we know","volume":"68","author":"Shahid Z","unstructured":"Shahid Z, , Kalayanamitra R, , McClafferty B, et al.: COVID-19 and older adults: What we know. J Am Geriatr Soc 2020;68:926\u2013929.","journal-title":"J Am Geriatr Soc"},{"key":"e_1_3_6_11_2","first-page":"1","article-title":"COVID-19 in older adults: Key points for emergency department providers","volume":"1","author":"Malone ML","unstructured":"Malone ML, , Hogan TM, , Perry A, et al.: COVID-19 in older adults: Key points for emergency department providers. J Geriatr Emerg Med 2020;1:1\u201311.","journal-title":"J Geriatr Emerg Med"},{"key":"e_1_3_6_12_2","first-page":"40","volume":"11","author":"Fadui N","unstructured":"Fadui N, , Elsayem AF, , Bruera E, : Integration of palliative care into COVID-19 pandemic planning. BMJ Support Palliat Care 2021;11:40\u201344.","journal-title":"BMJ Support Palliat Care"},{"key":"e_1_3_6_13_2","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1016\/j.jpainsymman.2020.08.007","article-title":"The experience of emergency department providers with embedded palliative care During COVID","volume":"60","author":"Aaronson LE","unstructured":"Aaronson LE, , Petrillo L, , Stoltenberg M, et al.: The experience of emergency department providers with embedded palliative care During COVID. J Pain Symptom Manage 2020;60:e35\u2013e43.","journal-title":"J Pain Symptom Manage"},{"key":"e_1_3_6_14_2","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1001\/jamainternmed.2020.2713","article-title":"Early intervention of palliative care in the emergency department during the COVID-19 pandemic","volume":"180","author":"Lee J","unstructured":"Lee J, , Abrukin L, , Flores S, et al.: Early intervention of palliative care in the emergency department during the COVID-19 pandemic. JAMA Intern Med 2020;180:1252\u20131254.","journal-title":"JAMA Intern Med"},{"key":"e_1_3_6_15_2","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.jemermed.2020.08.008","article-title":"Novel use of telepalliative care in a New York city emergency department during the COVID-19 pandemic","volume":"59","author":"Flores S","unstructured":"Flores S, , Abrukin L, , Jiang L, et al.: Novel use of telepalliative care in a New York city emergency department during the COVID-19 pandemic. J Emerg Med 2020;59:714\u2013716.","journal-title":"J Emerg Med"},{"key":"e_1_3_6_16_2","doi-asserted-by":"crossref","first-page":"e79","DOI":"10.1016\/j.jpainsymman.2020.04.025","article-title":"Palliative care in the time of COVID-19","volume":"60","author":"Mercadante S","unstructured":"Mercadante S, , Adile C, , Ferrera P, et al.: Palliative care in the time of COVID-19. J Pain Symptom Manage 2020;60:e79\u2013e80.","journal-title":"J Pain Symptom Manage"},{"key":"e_1_3_6_17_2","unstructured":"Department of Disease Control Thailand: Thailand situation for COVID-19 2021. https:\/\/ddc.moph.go.th\/viralpneumonia\/eng\/index.php (Last accessed December9 2021)."},{"key":"e_1_3_6_18_2","unstructured":"Department of Disease Control Thailand: Thailand situation for COVID-19 2021. https:\/\/ddc.moph.go.th\/viralpneumonia\/file\/scoreboard\/scoreboard_05022564.pdf (Last accessed December9 2021)."},{"key":"e_1_3_6_19_2","doi-asserted-by":"crossref","first-page":"103892","DOI":"10.1016\/j.archger.2019.05.017","article-title":"A comparison of preferences of elderly patients for end-of-life period and their relatives's perceptions in Thailand","volume":"84","author":"Srinonprasert V","year":"2019","unstructured":"Srinonprasert V, , Manjavong M, , Limpawattana P, et al.: A comparison of preferences of elderly patients for end-of-life period and their relatives's perceptions in Thailand. Arch Gerontol Geriatr, 2019; 84:103892.","journal-title":"Arch Gerontol Geriatr"},{"key":"e_1_3_6_20_2","doi-asserted-by":"crossref","first-page":"e02067","DOI":"10.1016\/j.heliyon.2019.e02067","article-title":"Perception of a \u201cgood death\u201d in Thai patients with cancer and their relatives","volume":"12","author":"Chindaprasert J","year":"2019","unstructured":"Chindaprasert J, , Wongtirawat N, , Limpawattana P, et al.: Perception of a \u201cgood death\u201d in Thai patients with cancer and their relatives. Heliyon, 2019; 12;5:e02067.","journal-title":"Heliyon"},{"key":"e_1_3_6_21_2","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1177\/0969733019826410","article-title":"Comparison of Thai older patients \u201cwishes and nurses\u201d perceptions regarding end-of-life care","volume":"26","author":"Manjavong M","unstructured":"Manjavong M, , Srinonprasert V, , Limpawattana P, et al.: Comparison of Thai older patients \u201cwishes and nurses\u201d perceptions regarding end-of-life care. Nurs Ethics 2019;26:2006\u20132015.","journal-title":"Nurs Ethics"},{"key":"e_1_3_6_22_2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1440-172X.2009.01730.x","volume":"15","author":"Sittisombut S","unstructured":"Sittisombut S, , Inthong S, : Surrogate decision-maker for end-of-life care in terminally ill patients at Chiang Mai University Hospital, Thailand. Int J Nurs Pract 2009;15:119\u2013125.","journal-title":"Int J Nurs Pract"},{"key":"e_1_3_6_23_2","doi-asserted-by":"crossref","unstructured":"Sri-on J Kredarunsooksree T Paksophis T et al.: Proposal for modifications to the Bangkok urban health system that would improve the quality of health independent living and maintenance of older adults with fall-related trauma (Bangkok falls study) 26 August 2021 PREPRINT (Version 1). https:\/\/doi.org\/10.21203\/rs.3.rs-428302\/v1 (Last accessed December1 2021).","DOI":"10.21203\/rs.3.rs-428302\/v1"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_3_6_25_2","first-page":"61","volume":"14","author":"Mahoney FI","unstructured":"Mahoney FI, , Barthel DW, : Functional evaluation: The Barthel index. Md Stat Med J 1965;14:61\u201365.","journal-title":"Md Stat Med J"},{"key":"e_1_3_6_26_2","unstructured":"Nesle Nutrition Institute: MNA Mini Nutritional Assessment. https:\/\/www.mna-elderly.com\/forms\/mini\/mna_mini_thai.pdf (Last accessed February6 2021)."},{"key":"e_1_3_6_27_2","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1002\/(SICI)1099-1166(199911)14:11<936::AID-GPS39>3.0.CO;2-1","article-title":"Validation of a 6 item cognitive impairment test with a view to primary care usage","volume":"14","author":"Brooke P","unstructured":"Brooke P, , Bullock R: Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry 1999;14:936\u2013940.","journal-title":"Int J Geriatr Psychiatry"},{"key":"e_1_3_6_28_2","unstructured":"World Health Organization: WHOQOL: Measuring quality of life 2012. https:\/\/www.who.int\/tools\/whoqol (Last accessed February6 2021)."},{"key":"e_1_3_6_29_2","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1191\/0269216305pm1036oa","article-title":"The development of a questionnaire to assess the attitudes of older people to end-of-life issues (AEOLI)","volume":"19","author":"Catt S","unstructured":"Catt S, , Blanchard M: The development of a questionnaire to assess the attitudes of older people to end-of-life issues (AEOLI). Palliat Med 2005;19:397\u2013401.","journal-title":"Palliat Med"},{"key":"e_1_3_6_30_2","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried LP","unstructured":"Fried LP, , Tangen CM, , Walston J, et al.: Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Med Sci 2001;56:M146\u2013M156.","journal-title":"J Gerontol A Biol Med Sci"},{"key":"e_1_3_6_31_2","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1089\/jpm.2017.0226","article-title":"Impact of patients' expressed wishes on their surrogate decision makers' preferred decision-making roles in Japan","volume":"21","author":"Tsuda S","unstructured":"Tsuda S, , Nakamura M, , Aoki S, et al.: Impact of patients' expressed wishes on their surrogate decision makers' preferred decision-making roles in Japan. J Palliat Med 2018;21:354\u2013360.","journal-title":"J Palliat Med"},{"key":"e_1_3_6_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2020.102291"},{"key":"e_1_3_6_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2020.101833"},{"key":"e_1_3_6_34_2","unstructured":"World Health Organization:. Modes of transmission of virus causing COVID-19: Implications for IPC precaution recommendations: Scientific brief 29 March 2020. https:\/\/apps.who.int\/iris\/handle\/10665\/331616 (Last accessed February23 2021)."},{"key":"e_1_3_6_35_2","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1177\/02692163211004228","article-title":"Missing the human connection: A rapid appraisal of healthcare workers' perceptions and experiences of providing palliative care during the COVID-19 pandemic","volume":"35","author":"Mitchinson L","unstructured":"Mitchinson L, , Dowrick A, , Buck C, et al.: Missing the human connection: A rapid appraisal of healthcare workers' perceptions and experiences of providing palliative care during the COVID-19 pandemic. Palliat Med 2021;35:852\u2013861.","journal-title":"Palliat Med"},{"key":"e_1_3_6_36_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16030365"},{"key":"e_1_3_6_37_2","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.pop.2019.05.006","article-title":"Cultural, religious, and spiritual issues in palliative care","volume":"46","author":"Mathew-Geevarughese SE","unstructured":"Mathew-Geevarughese SE, , Corza O, , Figuracion E: Cultural, religious, and spiritual issues in palliative care. Prim Care 2019;46:399\u2013413.","journal-title":"Prim Care"},{"key":"e_1_3_6_38_2","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1177\/1049909119832818","article-title":"Palliative care in myocardial Infarction: Patient characteristics and trends of service utilization in a national inpatient sample","volume":"36","author":"Abdullah AS","unstructured":"Abdullah AS, , Salama A, , Ibrahim H, et al.: Palliative care in myocardial Infarction: Patient characteristics and trends of service utilization in a national inpatient sample. Am J Hosp Palliat Care 2019;36:722\u2013726.","journal-title":"Am J Hosp Palliat Care"}],"container-title":["Palliative Medicine Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/pmr.2021.0084","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/pmr.2021.0084","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/pmr.2021.0084","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:56:33Z","timestamp":1777679793000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.1089\/pmr.2021.0084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,21]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.1089\/pmr.2021.0084"],"URL":"https:\/\/doi.org\/10.1089\/pmr.2021.0084","relation":{},"ISSN":["2689-2820","2689-2820"],"issn-type":[{"value":"2689-2820","type":"print"},{"value":"2689-2820","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,21]]},"article-number":"pmr.2021.0084"}}