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Titolo:
Age differences in care practices and outcomes for hospitalized patients with cancer
Autore:
Rose, JH; OToole, EE; Dawson, NV; Thomas, C; Connors, AF; Wenger, NS; Phillips, RS; Hamel, MB; Cohen, HJ; Lynn, J;
Indirizzi:
Case Western Reserve Univ, Sch Med, Dept Geriatr Med, Cleveland, OH 44120 USA Case Western Reserve Univ Cleveland OH USA 44120 Cleveland, OH 44120 USA Louis Stokes Cleveland VAMC, Cleveland, OH USA Louis Stokes Cleveland VAMC Cleveland OH USA and VAMC, Cleveland, OH USA Metrohlth Med Ctr, Ctr Hlth Care Res & Policy, Cleveland, OH USA MetrohlthMed Ctr Cleveland OH USA Care Res & Policy, Cleveland, OH 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 Beth Israel Deaconess Med Ctr, Boston, MA USA Beth Israel Deaconess Med Ctr Boston MA USA ness Med Ctr, Boston, MA USA Duke Univ, Sch Med, VAMC, Durham, NC USA Duke Univ Durham NC USADuke Univ, Sch Med, VAMC, Durham, NC USA George Washington Univ, Ctr Improve Care Dying, Washington, DC USA George Washington Univ Washington DC USA Care Dying, Washington, DC USA
Titolo Testata:
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
fascicolo: 5, volume: 48, anno: 2000, supplemento:, S
pagine: S25 - S32
SICI:
0002-8614(200005)48:5<S25:ADICPA>2.0.ZU;2-5
Fonte:
ISI
Lingua:
ENG
Soggetto:
SERIOUSLY ILL; PSYCHOSOCIAL IMPACT; YOUNGER PATIENTS; DYING PATIENTS; ADULTS; OLDER; PREFERENCES; LIFE; ILLNESS; DOCTORS;
Keywords:
aging; advanced cancer; hospitalization; decision making; end-of-life care;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Social & Behavioral Sciences
Clinical Medicine
Citazioni:
46
Recensione:
Indirizzi per estratti:
Indirizzo: Rose, JH Case Western Reserve Univ, Sch Med, Dept Geriatr Med, 12200 Fairhill Rd, Cleveland, OH 44120 USA Case Western Reserve Univ 12200 Fairhill RdCleveland OH USA 44120
Citazione:
J.H. Rose et al., "Age differences in care practices and outcomes for hospitalized patients with cancer", J AM GER SO, 48(5), 2000, pp. S25-S32

Abstract

OBJECTIVE: To identify age group differences in care practices and outcomes for seriously ill hospitalized patients with malignancy. DESIGN: Prospective cohort study (SUPPORT project). SETTING: Five United States teaching hospitals; data was gathered between 1989 and 1994. SUBJECTS: Nine hundred twenty five older (age greater than or equal to 65 years), 983 middle aged (age = 45-64 years), and 274 younger (age = 18-44 years) hospitalized patients receiving care for non-small cell lung cancer, colon cancer metastasized to the liver, or multi-organ system failure associated with malignancy. MEASUREMENTS: Care practices and patient outcomes were determined from hospital records. Length of survival was identified using the National Death Index. After adjusting for important variables, including severity of illness (i.e., SUPPORT model estimate for 2-month survival, cancer condition), hospital site, selection to intervention and sociodemographic variables, age group differences in care practices and outcomes were identified using general linear models. RESULTS: Older patients with cancer had lower resource utilization during hospitalization (P < .04) and were less likely to receive cancer-related treatments (i.e., chemotherapy, platelet infusions, scheduled intravenous medications) than middle-aged and young-adult patients in the first week of hospitalization (P < .01). More care topics were discussed with older patients and their families then with younger patients and their families (P < .001). Length of stay and total hospital costs were lower for older and middle-aged patients than for younger patients. Although more older patients had discussions about transfer to hospice (P < .001), older patients were no more likely to be discharged with supportive care (inpatient hospice or home with home/hospice care). Older patients died sooner than middle-aged patients (P < .01). CONCLUSIONS: Patient age influenced care decisions and outcomes. Older patients (age greater than or equal to 65 years) received less aggressive care, had more discussions about care decisions, and died sooner than younger patients with cancer. Younger patients had longer stays, higher hospital costs, and greater probability of rehospitalization. Although well over half of patients died within 6 months of hospitalization, few patients in any agegroup were discharged with supportive care. Future studies should examine age differences in palliation, as well as acute care of cancer patients across inpatient and ambulatory care settings and should assess quality of care at the end of life.

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Documento generato il 13/07/20 alle ore 11:05:09