End-of-Life Treatment Preferences Among Older Adults

Abstract

With the advancement of medical technology, various life-sustaining treatments are available at the end of life. Older adults should be encouraged to establish their end-of-life treatment preferences (ELTP) while they are physically and mentally able to do so. The purpose of this study was to explore ELTP among older adults and to compare those preferences in a subset of individuals who had reported their ELTP in a survey completed the previous year. This was a descriptive study of 191 older adults living in a continuing care retirement community. Approximately half of the participants did not want cardiopulmonary resuscitation, to be put on a respirator, or to receive dialysis. The findings in this study suggest that many older adults do not want aggressive interventions at the end of life, but choose rather those measures that will keep them comfortable. Moreover, treatment choices may change over time. Health care providers should initiate discussions about ELTP at regular intervals (yearly) to assist older adults in dictating their end-of-life care.

Keywords

advance directives end-of-life care end-of-life treatment preferences older adults

Get full access to this article

View all access options for this article.

References

Dunlap R. Teaching advance directives: the why, when, and how . J Gerontol Nurs 1997; 23: 11-16 .

Teno JM , Branco KJ , Mor V et al. Changes in advance care planning in nursing homes before and after the Self-determination Act: report of a 10-state survey . J Am Geriatr Soc 1997; 45: 939-944 .

Lo B. Ethics. In: Lonergan E ed. Geriatrics: a LANGE clinical manual. Stamford, CT: Appleton and Lange , 1996: 524-525.

Emanuel L , Emanuel E. The medical directive: a new comprehensive advance care document . JAMA 1989; 261: 3288-3293 .

Danis M , Garrett J , Harris R , Patrick DL. Stability of choices about life-sustaining treatments . Ann Intern Med 1994; 120: 567-573 .

Walker R , Schonwetter RS , Kramer DR , Robinson BE. Living wills and resuscitation preferences in an elderly population . Arch Intern Med 1995; 155: 171-175 .

Emanuel L. Advance directives. In: Berger A , Portenoy RK , Weissman DE , eds. Principles and practice of supportive oncology. Philadelphia, PA: Lippincott-Raven , 1998: 791-808.

Kellogg FR , Crain M , Corwin J , Brickner PW. Life-sustaining interventions in frail elderly persons: talking about choices . Arch Intern Med 1992; 152: 2317-2320 .

Gordon N , Shade S. Advance directives are more likely among seniors asked about end-of-life care preferences . Arch Intern Med 1999; 159: 701-704 .

10.

Mezey M , Miltty E , Ramsey G. Assessment of decision-making capacity: nursing’s role . J Gerontol Nurs 1997; 23: 28-35 .

11.

Eleazer GP , Hornung CA , Egbert CB et al. The relationship between ethnicity and advance directives in a frail older population . J Am Geriatr Soc 1996; 44: 938-943 .

12.

Folstein MF , Folstein SE , McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res 1975; 12: 189-198 .

13.

Ware JE , Kosinski M , Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity . Med Care 1996; 34: 220-233 .

14.

Ware JE , Kosinski M , Keller SD. SF-36 physical and mental health summary scales: a user’s manual. Boston, MA: The Health Institute, New England Medical Center , 1994.

15.

Ware JE , Kosinski M , Bayliss MS , McHorney CA , Rogers WH , Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study . Med Care 1995; 33(4 Suppl): AS264-AS279 .

16.

Phillips RS , Wenger NS , Teno J et al. Choices of seriously ill patients about cardiopulmonary resuscitation: correlates and outcomes . Am J Med 1996; 100: 128-137 .

17.

Latimer E. Ethical care at the end of life . Can Med Assoc J 1998; 158: 1741-1747 .