Abstract
OBJECTIVES: To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment. DESIGN: Mailed survey of older physicians. SETTING: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. PARTICIPANTS: Physicians who completed the life-sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n = 645, 83% of respondents to the 1998 questionnaire; mean age 68). MEASUREMENTS: Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette. RESULTS: Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6-year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR) = 2.14, 95% confidence interval (CI) = 1.18-3.88) to prefer high-burden life-sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR = 5.33, 95% CI = 1.60-17.8) to prefer high-burden treatment than respondents without declining function or worsening depression. CONCLUSION: This study calls attention to the need for clinical reassessment of preferences for potentially life-sustaining treatment when health has declined to prevent underestimating the preferences of older patients.
Original language | English (US) |
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Pages (from-to) | 577-582 |
Number of pages | 6 |
Journal | Journal of the American Geriatrics Society |
Volume | 52 |
Issue number | 4 |
DOIs | |
State | Published - Apr 2004 |
Keywords
- Advance directives
- Decision-making
- Depression
- Quality of life
- Resuscitation
ASJC Scopus subject areas
- Geriatrics and Gerontology