Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study

Joseph B. Straton, Nae Yuh Wang, Lucy Ann Meoni, Daniel E Ford, Michael John Klag, David Casarett, Joseph J Gallo

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)577-582
Number of pages6
JournalJournal of the American Geriatrics Society
Volume52
Issue number4
DOIs
StatePublished - Apr 2004

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Physicians
Therapeutics
Odds Ratio
Confidence Intervals
Patient Preference
Checklist
Medical Students
Health Status
Longitudinal Studies
Surveys and Questionnaires
Cohort Studies
Health

Keywords

  • Advance directives
  • Decision-making
  • Depression
  • Quality of life
  • Resuscitation

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

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title = "Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study",
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.",
keywords = "Advance directives, Decision-making, Depression, Quality of life, Resuscitation",
author = "Straton, {Joseph B.} and Wang, {Nae Yuh} and Meoni, {Lucy Ann} and Ford, {Daniel E} and Klag, {Michael John} and David Casarett and Gallo, {Joseph J}",
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AU - Straton, Joseph B.

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AU - Ford, Daniel E

AU - Klag, Michael John

AU - Casarett, David

AU - Gallo, Joseph J

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AB - 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.

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