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- Title
Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study.
- Authors
Straton, Joseph B.; Nae-Yuh Wang; Meoni, Lucy A.; Ford, Daniel E.; Klag, Michael J.; Casarett, David; Gallo, Joseph J.
- Abstract
To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment. Mailed survey of older physicians. Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. Physicians who completed the life-sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n=645, 83% of respondents to the 1998 questionnaire; mean age 68). Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette. Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6-year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR)=2.14, 95% confidence interval (CI)=1.18–3.88) to prefer high-burden life-sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR=5.33, 95% CI=1.60–17.8) to prefer high-burden treatment than respondents without declining function or worsening depression. This study calls attention to the need for clinical reassessment of preferences for potentially life-sustaining treatment when health has declined to prevent underestimating the preferences of older patients.
- Subjects
MENTAL depression; DEPRESSION in old age; MEDICAL care for older people; GERIATRICS; DECISION making; QUALITY of life; OLDER people
- Publication
Journal of the American Geriatrics Society, 2004, Vol 52, Issue 4, p577
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1111/j.1532-5415.2004.52165.x