title: Factors affecting physicians' decisions on caring for an incompetent elderly patient: an international study.
abstract: To determine what treatment decisions physicians will make when faced with a hypothetical incompetent elderly patient with life-threatening gastrointestinal bleeding and to examine the relative importance of physician characteristics and factors (legal and ethical concerns, hospital costs, level of dementia, patient's age, physician's religion, patient's wishes and family's wishes) in making those decisions.
  
  
  
  Survey.
  
  
  
  Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries.
  
  
  
  Physicians who regularly cared for incompetent elderly patients.
  
  
  
  A self-administered questionnaire describing the elderly patient. Respondents were asked to choose one of four levels of care and to identify the level of importance factors had in making that decision. Older physicians, those less concerned about litigation, those for whom the level of dementia was important and those for whom the patient's age was important were expected to give less aggressive care than the other physicians.
  
  
  
  Supportive care was chosen by 8.1% of the respondents, limited therapeutic care by 41.5%, maximum therapeutic care without admission to the intensive care unit (ICU) by 32.2% and maximum care with admission to the ICU by 18.2%. The patient's wishes were reported by 91.0% as being extremely or very important in choosing the treatment. Stepwise logistic regression analysis revealed that the following variables independently predicted the level of treatment: level of dementia, country of residence, duration of practice, legal concerns, patient's age and ethical concerns. These factors were significantly correlated with the physicians' treatment choices (p less than 0.05).
  
  
  
  The importance that the physicians placed on the level of dementia was the strongest predictor of the level of care that would be provided. A societal consensus on the influence of cognitive function on the appropriate level of care as well as training of physicians in ethical issues are required.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ont.
authors.forename: D W
authors.initials: DW
authors.lastname: Molloy
authors.forename: G H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: E
authors.initials: E
authors.lastname: Alemayehu
authors.forename: W
authors.initials: W
authors.lastname: McIlroy
authors.forename: A
authors.initials: A
authors.lastname: Willan
authors.forename: M
authors.initials: M
authors.lastname: Eisemann
authors.forename: G
authors.initials: G
authors.lastname: Abraham
authors.forename: J
authors.initials: J
authors.lastname: Basile
authors.forename: G
authors.initials: G
authors.lastname: Penington
authors.forename: M E
authors.initials: ME
authors.lastname: McMurdo
authors.forename: Paul
authors.initials: P
authors.lastname: Finucane
authors.forename: Alice
authors.initials: A
authors.lastname: Zelmanowicz
authors.forename: Michael
authors.initials: M
authors.lastname: Hyland
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D003704:Dementia / Q000150:complications / Q000523:psychology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy; D014943:Global Health; D006801:Humans; D008297:Male; D016743:Mental Competency; D010817:Physician-Patient Relations; D010820:Physicians / Q000706:statistics & numerical data*; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000145:classification* / Q000191:economics / Q000592:standards