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.
|Original language||English (US)|
|Number of pages||10|
|Journal||Annals of internal medicine|
|State||Published - Jan 19 1999|
ASJC Scopus subject areas
- Internal Medicine