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Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT.
J Am Geriatr Soc. 2000 05; 48(S1):S176-82.JA

Abstract

OBJECTIVES

To review previously published findings about how patient age influenced patterns of care for seriously ill patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).

DESIGN

An observational prospective study.

SETTING

Five acute care hospitals.

PARTICIPANTS

A total of 9105 seriously ill patients enrolled in SUPPORT.

MEASUREMENTS

The outcomes examined included patients' preferences for aggressive care, decision making regarding cardiopulmonary resuscitation and use of other life-sustaining treatments, hospital costs, intensity of resource use, and survival.

RESULTS

Although older patients preferred less aggressive care than younger patients, many older patients wanted cardiopulmonary resuscitation and care focused on life extension. Patients' families and healthcare providers underestimated older patients' desire for aggressive care. After adjustment for illness severity, comorbidity, baseline function, and patients' preferences for aggressive care, older age was associated with lower hospital costs and resource intensity and higher rates of decisions to withhold life-sustaining treatments. In adjusted analyses, older age was associated with a slight survival disadvantage. This survival disadvantage persisted, even after adjustment for aggressiveness of care, suggesting that the relation between age and survival is not accounted for by less aggressive treatment of older patients.

CONCLUSIONS

Even after adjustment for patients' prognoses and care preferences, seriously ill hospitalized older patients were treated less aggressively than younger patients. SUPPORT cannot fully identify whether the relationship between older age and less aggressive treatment is better explained by the withholding of potentially beneficial treatments from older patients, or by the excessive provision of ineffective treatment to younger patients. However, the latter explanation is favored by the SUPPORT finding that less aggressive treatment for older patients does not contribute to the modest survival disadvantage associated with older age.

Authors+Show Affiliations

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10809472

Citation

Hamel, M B., et al. "Age-related Differences in Care Preferences, Treatment Decisions, and Clinical Outcomes of Seriously Ill Hospitalized Adults: Lessons From SUPPORT." Journal of the American Geriatrics Society, vol. 48, no. S1, 2000, pp. S176-82.
Hamel MB, Lynn J, Teno JM, et al. Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT. J Am Geriatr Soc. 2000;48(S1):S176-82.
Hamel, M. B., Lynn, J., Teno, J. M., Covinsky, K. E., Wu, A. W., Galanos, A., Desbiens, N. A., & Phillips, R. S. (2000). Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT. Journal of the American Geriatrics Society, 48(S1), S176-82.
Hamel MB, et al. Age-related Differences in Care Preferences, Treatment Decisions, and Clinical Outcomes of Seriously Ill Hospitalized Adults: Lessons From SUPPORT. J Am Geriatr Soc. 2000;48(S1):S176-82. PubMed PMID: 10809472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT. AU - Hamel,M B, AU - Lynn,J, AU - Teno,J M, AU - Covinsky,K E, AU - Wu,A W, AU - Galanos,A, AU - Desbiens,N A, AU - Phillips,R S, PY - 2000/5/16/pubmed PY - 2000/6/8/medline PY - 2000/5/16/entrez KW - Death and Euthanasia KW - Empirical Approach KW - Professional Patient Relationship KW - Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) SP - S176 EP - 82 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 48 IS - S1 N2 - OBJECTIVES: To review previously published findings about how patient age influenced patterns of care for seriously ill patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). DESIGN: An observational prospective study. SETTING: Five acute care hospitals. PARTICIPANTS: A total of 9105 seriously ill patients enrolled in SUPPORT. MEASUREMENTS: The outcomes examined included patients' preferences for aggressive care, decision making regarding cardiopulmonary resuscitation and use of other life-sustaining treatments, hospital costs, intensity of resource use, and survival. RESULTS: Although older patients preferred less aggressive care than younger patients, many older patients wanted cardiopulmonary resuscitation and care focused on life extension. Patients' families and healthcare providers underestimated older patients' desire for aggressive care. After adjustment for illness severity, comorbidity, baseline function, and patients' preferences for aggressive care, older age was associated with lower hospital costs and resource intensity and higher rates of decisions to withhold life-sustaining treatments. In adjusted analyses, older age was associated with a slight survival disadvantage. This survival disadvantage persisted, even after adjustment for aggressiveness of care, suggesting that the relation between age and survival is not accounted for by less aggressive treatment of older patients. CONCLUSIONS: Even after adjustment for patients' prognoses and care preferences, seriously ill hospitalized older patients were treated less aggressively than younger patients. SUPPORT cannot fully identify whether the relationship between older age and less aggressive treatment is better explained by the withholding of potentially beneficial treatments from older patients, or by the excessive provision of ineffective treatment to younger patients. However, the latter explanation is favored by the SUPPORT finding that less aggressive treatment for older patients does not contribute to the modest survival disadvantage associated with older age. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/10809472/Age_related_differences_in_care_preferences_treatment_decisions_and_clinical_outcomes_of_seriously_ill_hospitalized_adults:_lessons_from_SUPPORT_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2000&volume=48&issue=S1&spage=S176 DB - PRIME DP - Unbound Medicine ER -