Older Patients Get Less Aggressive Treatment, Regardless of Health Status or Their Own Preferences, Study Finds

Study of the role of advanced patient age on decision making, outcomes, and cost effectiveness

Starting in 1997, investigators at the Beth Israel Deaconess Medical Center, Boston, analyzed the effects of advanced patient age on resource use in hospitals, clinical outcomes for the patient and the cost-effectiveness of selected life-sustaining treatments.

The analysis used data from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). See the 1997 Robert Wood Johnson Foundation Anthology chapter, "Insights from SUPPORT"), a seminal study of the end-of-life experience of seriously ill hospitalized patients.

This project was part of RWJF's Targeted End-of Life Projects Initiative, which advances RWJF's objective to improve care at the end of life.

Key Findings

  • Age-related differences in treatment decisions, clinical outcomes and cost- effectiveness of life-extending care for seriously ill hospitalized adults.

    • After adjusting for differences in patients' prognoses and preferences for cardiopulmonary resuscitation and life-extending care, older age was associated with higher rates of decisions to withhold ventilator support, surgery and dialysis.
    • In a study to determine the effect of age on short-term survival, investigators found a modest independent association between older patient age and shorter survival in the six months following serious illness, after adjusting for patients' baseline functional status and severity of illness.
  • Factors associated with treatment decisions for patients at the end of life.

    • Patient race is associated with decreased resource use for seriously ill hospitalized patients.
    • In an observational study of patients hospitalized with congestive heart failure, care by a cardiologist rather than a generalist was associated with greater costs and resource use and no difference in survival after 30 days. However, there was a trend toward improved survival among patients of cardiologists at one year.
  • Preferences for care among patients at the end of life.

    • In a study of patients with severe congestive heart failure, almost one-quarter expressed a preference not to be resuscitated.
    • Patients with metastatic colon and lung cancer (cancer spreading to other parts of the body) overestimate their survival probabilities, which may influence their preferences about medical therapies.
  • How people die with different diseases.

    • Investigators studying the last six months of life for patients with lung cancer and colon cancer reported that this period is characterized by functional decline and poorly controlled severe pain and confusion.
    • Investigators studying the last six months of life for patients with congestive heart failure reported that illness becomes more severe, disability and the experience of certain symptoms more frequent and patient preference not to be resuscitated more common.
  • Analyses of the cost-effectiveness of life-extending treatments.

    • Investigators' findings showed that compared with other medical interventions, dialysis is not cost-effective for patients with average prognoses who develop renal failure in the context of serious illness.