The use of life-sustaining treatments in hospitalized persons aged 80 and older.
OBJECTIVE
To characterize the use of life-sustaining treatments in hospitalized patients aged 80 and older.


METHODS
A prospective cohort study.


METHODS
Four teaching hospitals in the United States that participated in the Hospitalized Elderly Longitudinal Project (HELP).


METHODS
Hospitalized patients aged 80 and older.


METHODS
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.


CONCLUSIONS
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.
Somogyi-Zalud
Emese
E
Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817, USA. emesesz@msn.com
Zhong
Zhenshao
Z
Hamel
Mary Beth
MB
Lynn
Joanne
J
D024362:Advance Directive Adherence; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate