The effect of recovery from depression on preferences for life-sustaining therapy in older patients

Background. This study compared older veterans' preferences about life- sustaining therapy before and after treatment for depression in order to determine whether recovery from depression is associated with an increase in the desire for these interventions. Methods. Medical inpatients over 65 years of age were eligible. Depressed subjects scored >14 on the Geriatric Depression Scale and were independently diagnosed by a psychiatrist as depressed. A questionnaire quantified preferences regarding potentially life- sustaining interventions currently, and in four hypothetical scenarios of illness. Results. Initial interviews were completed on 50 depressed and 50 nondepressed subjects. Within 6 months, 34 (68%) depressed and 40 (80%) control subjects were reevaluated. Preferences did not change significantly from initial to final interview, regardless of whether subjects had recovered from depression or remained depressed. With the exception of cardiopulmonary resuscitation, however, control subjects' preferences were more stable than depressed subjects' choices. Conclusions. This study demonstrated that treatment of mild-to-moderate depression does not necessarily result in an increased desire for life-sustaining medical therapy. Because depressed patients exhibit less consistency in their preferences over time, we advise careful and repeated discussions with the depressed patient regarding these decisions.