The Use of Life-Sustaining Treatments in Hospitalized Persons Aged 80 and Older

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 50; no. 5; pp. 930 - 934
• Main Authors: Somogyi-Zalud, Emese, Zhong, Zhenshao, Hamel, Mary Beth, Lynn, Joanne
• Format: Journal Article
• Language: English
• Published: Boston, MA, USA Blackwell Science Inc 01.05.2002; Blackwell; Wiley Subscription Services, Inc
• Subjects: Advance Directive Adherence; Age Factors; Aged; Aged, 80 and over; Bioethics; Biological and medical sciences; Cohort Studies; Decision Making; Elderly people; Female; Health care; Hospital Mortality; Hospitalization; Hospitalization - statistics & numerical data; hospitalized; Hospitals; Humans; Life Support Care - statistics & numerical data; Life sustaining treatment; life-sustaining treatments; Male; Medical sciences; Miscellaneous; older; Older people; Patient Satisfaction - statistics & numerical data; Prognosis; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; Survival Rate; USA; Human; Intensive care; Oldest old; Use; Hospitalization; Cost benefit analysis; Care; Prospective; Treatment; Cohort study; Quality; Hospital; Technique; Elderly; Resuscitation; Empirical Approach; Death and Euthanasia; Professional Patient Relationship; Hospitalized Elderly Longitudinal Project (HELP)
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1046/j.1532-5415.2002.50222.x

OBJECTIVES: To characterize the use of life‐sustaining treatments in hospitalized patients aged 80 and older. DESIGN: A prospective cohort study. SETTING: Four teaching hospitals in the United States that participated in the Hospitalized Elderly Longitudinal Project (HELP). PARTICIPANTS: Hospitalized patients aged 80 and older. MEASUREMENTS: We report the rates of admissions to intensive and coronary care units and the rates of use of cardiopulmonary resuscitation (CPR), ventilators, right heart catheterization, artificial nutrition and hydration, surgical interventions, hemodialysis, and blood transfusions. RESULTS: Of the 1,266 patients enrolled in HELP, 72 died during the enrollment hospitalization. The median age of those who died was 86 (range 83–89). Of the patients who died, the median number of activities of daily living impairments was two (range 1–4) before hospitalization, and 70% reported their baseline quality of life as fair or poor. Most patients who died had stated that they did not want aggressive care; 70% wanted their care focused on comfort rather than prolonging life, and 80% had a do‐not‐resuscitate order. However, the majority (63%) of the patients received one or more life‐sustaining treatments before they died. Fifty‐four percent were admitted to intensive or coronary care units, 43% were on a ventilator, 18% received CPR, 18% received tube feeding, 17% underwent surgery, 15% had right heart catheterization, 14% received blood transfusions, and 6% had hemodialysis. Intensive care did not affect survival time. CONCLUSION: The use of life‐sustaining treatments was prevalent in very old patients who died in the course of hospitalization, despite the fact that the majority had a preference for comfort care. This lack of congruence warrants further investigation and efforts to provide care that is more consistent with patients' preferences.