title: Health outcome priorities among competing cardiovascular, fall injury, and medication-related symptom outcomes.
abstract: OBJECTIVE
  To determine the priority that older adults with coexisting hypertension and fall risk give to optimizing cardiovascular outcomes versus fall- and medication symptom-related outcomes.
  
  
  METHODS
  Interview.
  
  
  METHODS
  Community.
  
  
  METHODS
  One hundred twenty-three cognitively intact persons aged 70 and older with hypertension and fall risk.
  
  
  METHODS
  Discrete choice task was used to elicit the relative importance placed on reducing the risk of three outcomes: cardiovascular events, serious fall injuries, and medication symptoms. Risk estimates with and without antihypertensive medications were obtained from the literature. Participants chose between 11 pairs of options that displayed lower risks for one or two outcomes and a higher risk for the other outcome(s), versus the reverse. Results were used to calculate relative importance scores for the three outcomes. These scores, which sum to 100, reflect the relative priority participants placed on the difference between the risk estimates of each outcome.
  
  
  RESULTS
  Sixty-two participants (50.4%) placed greater importance on reducing risk of cardiovascular events than reducing risk of the combination of fall injuries and medication symptoms; 61 participants did the converse. A lower percentage of participants with chronic obstructive pulmonary disease (P=.02), unsteadiness (P=.02), functional dependency (P=.04), lower cognition (P=.02) and depressive symptoms (P=.03) prioritized cardiovascular outcomes over fall injuries and medication symptoms than did participants without these characteristics.
  
  
  CONCLUSIONS
  Interindividual variability in the face of competing outcomes supports individualizing decision-making to individual priorities. In the current example, this may mean forgoing antihypertensive medications or compromising on blood pressure reduction for some individuals.
authors.affiliation: Department of Internal Medicine and Epidemiology, New Haven, Connecticut 06504, USA. mary.tinetti@yale.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.forename: Gail J
authors.initials: GJ
authors.lastname: McAvay
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
authors.forename: Heather G
authors.initials: HG
authors.lastname: Allore
authors.forename: Joanna C
authors.initials: JC
authors.lastname: Salmon
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Foody
authors.forename: Luann
authors.initials: L
authors.lastname: Bianco
authors.forename: Sandra
authors.initials: S
authors.lastname: Ginter
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003657:Decision Making; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D006292:Health Priorities; D006306:Health Surveys; D006801:Humans; D007206:Individuality; D008297:Male; D051346:Mobility Limitation; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology; D014947:Wounds and Injuries / Q000517:prevention & control*
chemical_list: D000959:Antihypertensive Agents