Are Preferences for Aggressive Medical Treatment Associated with Healthcare Utilization in the Very Old?

作者：Albert Steven M^*; Lunney June R; Ye Lei; Boudreau Robert; Ives Diane; Satterfield Suzanne; Kaplan Cameron M; Waters Teresa; Ayonayon Hilsa N; Rubin Susan M; Newman Anne B; Harris Tamara

来源：Journal of Palliative Medicine, 2017, 20(6): 618-624.

DOI：10.1089/jpm.2016.0284

• cohort studies
• end-of-life
• Health ABC
• healthcare utilization
• treatment preferences

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.

• 出版日期2017-6