Major depression and refusal of life-sustaining medical treatment in the elderly.
OBJECTIVE
To examine the effect of improvement or recovery from major depression in elderly patients on their desire for life-sustaining treatments.


METHODS
Prospective case survey.


METHODS
Psychogeriatric Service of Hornsby Ku-ring-gai Hospital & Community Health Services and Ryde Hospital & Community Health Services (a community-based service serving an urban population with over 29,000 elderly people).


METHODS
All patients referred with major depression (diagnosed by DSM-IV criteria) and no significant cognitive impairment between October 1994 and January 1995.


METHODS
Number of life-sustaining treatments desired before and after treatment of depression in two hypothetical acute life-threatening illnesses (one with a good and the other with an uncertain prognosis), and intensity of depression on the Geriatric Depression Scale (GDS).


RESULTS
22 subjects completed both stages of the study. Initial depression was severe in five, moderate in 16 and mild in one. GDS scores decreased in 18 subjects after treatment. Mean number of life-sustaining treatments desired by these patients increased significantly from 4.0 to 6.1 (out of seven possible treatments) in the "good prognosis" illness and from 6.4 to to 9.6 (out of 14) overall. The increase in the "uncertain prognosis" illness (2.3 to 3.4) was not significant.


CONCLUSIONS
Moderate or severe major depression in the elderly is associated with a high degree of refusal of life-sustaining treatments. Treatment of the depression leads to increased acceptance of these treatments, particularly if prognosis is good.
Department of Mental Health, Hornsby Ku-Ring-Gai Hospital, Sydney, NSW.
S C
SC
Hooper
K J
KJ
Vaughan
C C
CC
Tennant
J M
JM
Perz
D000368:Aged; D001294:Attitude to Health; D003657:Decision Making; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008020:Life Support Care; D008297:Male; D009517:New South Wales; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016312:Treatment Refusal