Are Preferences for Aggressive Medical Treatment Associated with Healthcare Utilization in the Very Old?
Objectives:To examine the relationship between end-of-life (EOL) treatment preferences and recent hospitalization or emergency department (ED) care in the very old.Design:Quarterly telephone follow-up of participants in the EOL in the Very Old cohort.Setting:The EOL in the Very Old Age cohort drew from 1403 participants in the Health, Aging, and Body Composition (Health ABC) study who were alive in year 15 of follow-up. 87.5% (n= 1227) were successfully recontacted and enrolled.Participants:Preferences for treatment at the EOL and reported hospital and ED use were examined for 1118 participants (18% involving proxy reports) over 6 months, 1021 (16% with proxy reports) over 12 months, and 945 (23% with proxy reports) over 18 months in 6-month intervals.Measurements:Preferences for eight EOL treatments, elicited once each year; hospitalization and ED use reported every six months.Results:Preferences for more aggressive treatment (endorsing ≥5 of 8 options) were not significantly associated with inpatient or ED treatment. Inpatient and ED treatment were not associated with changes in preferences for aggressive EOL treatment over 12 months.Conclusion:Alternative measures that tap attitudes toward routine care, rather than EOL treatment preferences, may be more highly associated with healthcare utilization.
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Steven M
SM
Albert
Hospital and Palliative Nursing Association, Pittsburgh, Pennsylvania.
June R
JR
Lunney
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Lei
L
Ye
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Robert
R
Boudreau
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Diane
D
Ives
Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee.
Suzanne
S
Satterfield
Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee.
Cameron M
CM
Kaplan
Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee.
Teresa
T
Waters
Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
Hilsa N
HN
Ayonayon
Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
Susan M
SM
Rubin
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Anne B
AB
Newman
Laboratory of Epidemiology, Biometry, and Demography, National Institute on Aging, Bethesda, Maryland.
Tamara
T
Harris
Health ABC; cohort studies; end-of-life; healthcare utilization; treatment preferences