Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: Lessons from support

Mary Beth Hamel, Joanne Lynn, Joan Teno, Kenneth E. Covinsky, Albert W. Wu, Anthony Galanos, Norman A. Desbiens, Russell S. Phillips

Research output: Contribution to journalReview article

102 Citations (Scopus)

Abstract

OBJECTIVES: To review previously published findings about how patient age influenced patterns of care for seriously ill patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). DESIGN: An observational prospective study. SETTING: Five acute care hospitals. PARTICIPANTS: A total of 9105 seriously ill patients enrolled in SUPPORT. MEASUREMENTS: The outcomes examined included patients' preferences for aggressive care, decision making regarding cardiopulmonary resuscitation and use of other life-sustaining treatments, hospital costs, intensity of resource use, and survival. RESULTS: Although older patients preferred less aggressive care than younger patients, many older patients wanted cardiopulmonary resuscitation and care focused on life extension. Patients' families and healthcare providers underestimated older patients' desire for aggressive care. After adjustment for illness severity, comorbidity, baseline function, and patients' preferences for aggressive care, older age was associated with lower hospital costs and resource intensity and higher rates of decisions to withhold life-sustaining treatments. In adjusted analyses, older age was associated with a slight survival disadvantage. This survival disadvantage persisted, even after adjustment for aggressiveness of care, suggesting that the relation between age and survival is not accounted for by less aggressive treatment of older patients. CONCLUSIONS: Even after adjustment for patients' prognoses and care preferences, seriously ill hospitalized older patients were treated less aggressively than younger patients. SUPPORT cannot fully identify whether the relationship between older age and less aggressive treatment is better explained by the withholding of potentially beneficial treatments from older patients, or by the excessive provision of ineffective treatment to younger patients. However, the latter explanation is favored by the SUPPORT finding that less aggressive treatment for older patients does not contribute to the modest survival disadvantage associated with older age.

Original languageEnglish (US)
Pages (from-to)S176-S182
JournalJournal of the American Geriatrics Society
Volume48
Issue numberS1
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

Fingerprint

Therapeutics
Survival
Patient Preference
Hospital Costs
Cardiopulmonary Resuscitation
Patient Care
Life Expectancy
Health Personnel
Health Care Costs
Observational Studies
Comorbidity
Decision Making
Prospective Studies

Keywords

  • age factors
  • aged
  • decision-making
  • health services research
  • outcome assessment

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults : Lessons from support. / Hamel, Mary Beth; Lynn, Joanne; Teno, Joan; Covinsky, Kenneth E.; Wu, Albert W.; Galanos, Anthony; Desbiens, Norman A.; Phillips, Russell S.

In: Journal of the American Geriatrics Society, Vol. 48, No. S1, 01.01.2000, p. S176-S182.

Research output: Contribution to journalReview article

Hamel, Mary Beth ; Lynn, Joanne ; Teno, Joan ; Covinsky, Kenneth E. ; Wu, Albert W. ; Galanos, Anthony ; Desbiens, Norman A. ; Phillips, Russell S. / Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults : Lessons from support. In: Journal of the American Geriatrics Society. 2000 ; Vol. 48, No. S1. pp. S176-S182.
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AU - Covinsky, Kenneth E.

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AU - Desbiens, Norman A.

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