title: Preferences and actual treatment of older adults at the end of life. A mortality follow-back study.
abstract: OBJECTIVE
  To compare actual treatments with preferences for starting or forgoing treatment of older adults at the end of life.
  
  
  METHODS
  Mortality follow-back study of relatives of deceased older adults. Preferences and actual treatment were studied for each of four treatments: starting or forgoing resuscitation (do not resuscitate), artificial nutrition and hydration (ANH), antibiotics, and artificial respiration.
  
  
  METHODS
  Older adults in the Netherlands.
  
  
  METHODS
  Proxies of deceased members (in 2006-2009) of two cohorts representative of the older Dutch population (n = 168) and of people with an advance directive (n = 184).
  
  
  METHODS
  Relationship between preferred and actual treatment.
  
  
  RESULTS
  In most individuals who preferred receiving treatment, this preference was followed (n = 2/2, resuscitation; 23/26, ANH; 33/38, antibiotics; 23/24, AR). In approximately half of the individuals who preferred that a treatment be forgone, the preference was followed (n = 6/13, resuscitation; 11/18, ANH; 3/5, antibiotics), except for artificial respiration (n = 1/8). The majority of people for whom no preference was known received treatment (n = 5/9, resuscitation; 19/33, ANH; 15/20, antibiotics; 8/13, artificial respiration). People with a known preference for receiving a specific treatment had a seven times higher chance of preference being followed than people with a known preference for forgoing that treatment. People with a known preference for forgoing a treatment had a six times higher chance of treatment being forgone than people having no known preference.
  
  
  CONCLUSIONS
  Although concordance between preferred and actual treatment is high in older adults who prefer treatment and lower in people who prefer no treatment, making preferences for forgoing treatment known is useful because it increases the chance of treatments being forgone in those who wish so.
authors.affiliation: Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam, The Netherlands.
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Pam J
authors.initials: PJ
authors.lastname: Kaspers
authors.forename: Dorly J H
authors.initials: DJ
authors.lastname: Deeg
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D019727:Proxy; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013727:Terminal Care / Q000379:methods*; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data*
keywords: advance care planning; advance directive; end-of-life care; forgoing treatment; individual preferences