TY - JOUR
T1 - Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults
AU - Hamel, Mary Beth
AU - Teno, Joan M.
AU - Goldman, Lee
AU - Lynn, Joanne
AU - Davis, Roger B.
AU - Galanos, Anthony N.
AU - Desbiens, Norman
AU - Connors, Alfred F.
AU - Wenger, Neil
AU - Phillips, Russell S.
PY - 1999/1/19
Y1 - 1999/1/19
N2 - Background: Patient age may influence decisions to withhold life- sustaining treatments, independent of patients' preferences for or ability to benefit from such treatments. Controversy exists about the appropriateness of using age as a criterion for making treatment decisions. Objective: To determine the effect of age on decisions to withhold life-sustaining therapies. Design: Prospective cohort study. Setting: Five medical centers participating in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Patients: 9105 hospitalized adults who had one of nine illnesses associated with an average 6-month mortality rate of 50%. Measurements: Outcomes were the presence and timing of decisions to withhold ventilator support, surgery, and dialysis. Adjustment was made for sociodemographic characteristics, prognoses, baseline function, patients' preferences for life-extending care, and physicians' understanding of patients' preferences for life-extending care. Results: The median patient age was 63 years; 44% of patients were women, and 53% survived to 180 days, in adjusted analyses, older age was associated with higher rates of withholding each of the three life-sustaining treatments studied. For ventilator support, the rate of decisions to withhold therapy increased 15% with each decade of age (hazard ratio, 1.15 [95% Cl, 1.12 to 1.19]); for surgery, the increase per decade was 19% (hazard ratio, 1.19 [Cl, 1.12 to 1.27]); and for dialysis, the increase per decade was 12% (hazard ratio, 1.12 [Cl, 1.06 to 1.19]). Physicians underestimated older patients' preferences for life-extending care; adjustment for this underestimation resulted in an attenuation of the association between age and decisions to withhold treatments. Conclusion: Even after adjustment for differences in patients' prognoses and preferences, older age was associated with higher rates of decisions to withhold ventilator support, surgery, and dialysis.
AB - Background: Patient age may influence decisions to withhold life- sustaining treatments, independent of patients' preferences for or ability to benefit from such treatments. Controversy exists about the appropriateness of using age as a criterion for making treatment decisions. Objective: To determine the effect of age on decisions to withhold life-sustaining therapies. Design: Prospective cohort study. Setting: Five medical centers participating in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Patients: 9105 hospitalized adults who had one of nine illnesses associated with an average 6-month mortality rate of 50%. Measurements: Outcomes were the presence and timing of decisions to withhold ventilator support, surgery, and dialysis. Adjustment was made for sociodemographic characteristics, prognoses, baseline function, patients' preferences for life-extending care, and physicians' understanding of patients' preferences for life-extending care. Results: The median patient age was 63 years; 44% of patients were women, and 53% survived to 180 days, in adjusted analyses, older age was associated with higher rates of withholding each of the three life-sustaining treatments studied. For ventilator support, the rate of decisions to withhold therapy increased 15% with each decade of age (hazard ratio, 1.15 [95% Cl, 1.12 to 1.19]); for surgery, the increase per decade was 19% (hazard ratio, 1.19 [Cl, 1.12 to 1.27]); and for dialysis, the increase per decade was 12% (hazard ratio, 1.12 [Cl, 1.06 to 1.19]). Physicians underestimated older patients' preferences for life-extending care; adjustment for this underestimation resulted in an attenuation of the association between age and decisions to withhold treatments. Conclusion: Even after adjustment for differences in patients' prognoses and preferences, older age was associated with higher rates of decisions to withhold ventilator support, surgery, and dialysis.
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U2 - 10.7326/0003-4819-130-2-199901190-00005
DO - 10.7326/0003-4819-130-2-199901190-00005
M3 - Article
C2 - 10068357
AN - SCOPUS:0033582183
SN - 0003-4819
VL - 130
SP - 116
EP - 125
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 2
ER -