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Titolo:
Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults
Autore:
Hamel, MB; Teno, JM; Goldman, L; Lynn, J; Davis, RB; Galanos, AN; Desbiens, N; Connors, AF; Wenger, N; Phillips, RS;
Indirizzi:
Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Boston, MA 02215 Beth Israel Deaconess Med Ctr Boston MA USA 02215 Care, Boston, MA 02215 Brown Univ, Ctr Gerontol & Hlth Care Res, Providence, RI 02912 USA Brown Univ Providence RI USA 02912 lth Care Res, Providence, RI 02912 USA Univ Calif San Francisco, Dept Med, Sch Med, San Francisco, CA 94143 USA Univ Calif San Francisco San Francisco CA USA 94143 ancisco, CA 94143 USA George Washington Univ, Washington, DC USA George Washington Univ Washington DC USA ington Univ, Washington, DC USA Duke Univ, Med Ctr, Durham, NC USA Duke Univ Durham NC USADuke Univ, Med Ctr, Durham, NC USA Univ Tennessee, Coll Med, Chattanooga, TN USA Univ Tennessee Chattanooga TN USA nnessee, Coll Med, Chattanooga, TN USA Univ Virginia, Sch Med, Charlottesville, VA 22908 USA Univ Virginia Charlottesville VA USA 22908 Charlottesville, VA 22908 USA Univ Calif Los Angeles, Sch Med, Los Angeles, CA USA Univ Calif Los Angeles Los Angeles CA USA , Sch Med, Los Angeles, CA USA
Titolo Testata:
ANNALS OF INTERNAL MEDICINE
fascicolo: 2, volume: 130, anno: 1999,
pagine: 116 -
SICI:
0003-4819(19990119)130:2<116:PAADTW>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE MYOCARDIAL-INFARCTION; CARDIOPULMONARY-RESUSCITATION; PATIENTS PREFERENCES; CARE; PATTERNS; SURVIVAL; SUPPORT; TRENDS; WORK; OLD;
Keywords:
age factors; life support care; decision making; health care rationing; health resources;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
47
Recensione:
Indirizzi per estratti:
Indirizzo: Hamel, MB Bethe,srael Deaconess Med Ctr, Div Gen Med & Primary Care, 330 Brookline Av Beth Israel Deaconess Med Ctr 330 Brookline Ave Boston MA USA 02215
Citazione:
M.B. Hamel et al., "Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults", ANN INT MED, 130(2), 1999, pp. 116

Abstract

Background: Patient age may influence decisions to withhold life-sustaining treatments, independent of patients' preferences for or ability to benefit from such treatments. Controversy exists about the appropriateness of using age as a criterion for making treatment decisions. Objective: To determine the effect of age on decisions to withhold life-sustaining therapies. Design: Prospective cohort study. Setting: Five medical centers participating in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Patients: 9105 hospitalized adults who had one of nine illnesses associated with an average 6-month mortality rate of 50%. Measurements: Outcomes were the presence and timing of decisions to withhold ventilator support, surgery, and dialysis. Adjustment was made for sociodemographic characteristics, prognoses, baseline function, patients' preferences for life-extending care, and physicians' understanding of patients' preferences for life-extending care. Results: The median patient age was 63 years; 44% of patients were women, and 53% survived to 180 days. In adjusted analyses, older age was associated with higher rates of withholding each of the three life-sustaining treatments studied. For ventilator support, the rate of decisions to withhold therapy increased 15% with each decade of age (hazard ratio, 1.15 [95% CI, 1.12 to 1.19]); for surgery, the increase per decade was 19% (hazard ratio, 1.19 [CI, 1.12 to 1.27]); and for dialysis, the increase per decade was 12% (hazard ratio, 1.12 [CI, 1.06 to 1.19]). Physicians underestimated older patients' preferences for life-extending care; adjustment for this underestimation resulted in an attenuation of the association between age and decisions to withhold treatments. Conclusion: Even after adjustment for differences in patients' prognoses and preferences, older age was associated with higher rates of decisions to withhold ventilator support, surgery, and dialysis.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/09/20 alle ore 16:42:55