Seniors Tend to Stick With End-of-Life Care Preferences

By Alan Mozes
HealthDay Reporter
Monday, October 27, 2008; 12:00 AM

MONDAY, Oct. 27 (HealthDay News) - Regardless of declines in either mental or physical health, most senior citizens do not change their outlook on how they want their end-of-life care to be when the time comes, new research suggests.

The study notes, however, that despite observing an overall stability in patient perspective, certain patients do seem to change their mind over time.

"We found that the people who wanted the least [aggressive treatment] were the most likely to continue wanting the least, whereas the people wanting the most were the most likely to change over to wanting less over time," noted study author Dr. Marsha N. Wittink from the department of family medicine and community health at the University of Pennsylvania School of Medicine in Philadelphia.

Wittink and her team published the observations in the Oct. 27 issue of theArchives of Internal Medicine.

Their findings are based on a comparative analysis of two end-of-life treatment preference questionnaires completed by 818 physicians, all of whom graduated from Johns Hopkins University between 1948 and 1964.

At an average age of 69 when the study was launched, all the participants completed an initial survey in 1999, followed by a second survey in 2002.

At both times, the patients were asked to indicate which types of interventions they would want should they experience brain death that rendered them unable to either speak or recognize those around them. Possible interventions included surgery, insertion of a feeding tube, dialysis, and/or cardiopulmonary resuscitation.

Serious changes in the participants' physical and/or mental health over the course of the intervening three years were also monitored.

The research team found that the overall percentage of study participants who fell into each level of treatment preference --"aggressive," "intermediate" or "least aggressive"-- remained pretty constant over the three years, as patients who turned down particular treatments in 1999 continued to be likely to do so in 2002.

Specifically, while 12 percent, 26 percent and 62 percent respectively preferred aggressive, intermediate or least aggressive treatment in 1999, overall preferences had shifted only slightly by 2002: to 14 percent, 26 percent and 60 percent, respectively.

Getting older or experiencing a decline in either mental or physical health did not appear to impact patient preferences, the researchers noted.

However, although the absolute numbers of those choosing one type of treatment approach or another remained more or less constant, individuals didn't necessarily stay in their original category, with some gravitating towards more or less aggressive intervention over time.


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