*for 1 person unknown if treatment was performed problems with eating and drinking (n=77) forgoing...

*For 1 person unknown if treatment was performed

Problems with eating and drinking (n=77)

Forgoing treatment in older people: are patient preferences being followed?

P.J. Kaspers, MSc1

H.R.W. Pasman, PhD1

D.J.H. Deeg, PhD2

B.D. Onwuteaka-Philipsen, PhD1

1Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre,

Amsterdam, The Netherlands2Department of Psychiatry, EMGO Institute for Health and Care

Research, VU University Medical Centre/LASA, Amsterdam, the Netherlands

[email protected]

*For 1 or 2 person(s) unknown if treatment was performed

Respiratory Insufficiency (n=45)

BACKGROUND

Population aging, combined with enhanced medical possibilities, confronts physicians more and more with the dilemma whether or not to perform life-prolonging treatment in older people.

Research on the direct relationship between patient’s preferences and actual decision in practice have not been investigated in depth yet.

OBJECTIVEThe aim is to study whether preferences of older people on (non-) treatment are being followed in end-of-life decisions in the last three months of life.

METHODS•Written questionnaire•Sample of proxy respondents of deceased participants of Longitudinal Aging Study Amsterdam (LASA, n=168) •Sample of proxy respondents of deceased participants of Advance Directive Cohort (ADC, n=184)•Life-prolonging treatments: resuscitation, artificial nutrition and fluids, antibiotics, artificial respiration•Participants included in the analyses if a person got in a situation that one of 4 life-prolonging treatments had to be made

RESULTSAll Fig: actual decision taken and the relation with preferences (absolute n and rounded %); in italic if decision are in accordance with preference

Cardiac Arrest (n=24)KNOWN PREFRESUSCITATION

n=15

UNKNOWN PREFRESUCITATION

n=9*

YES, DO RESUCITATE

n= 2 (13%)

NO, DO NOT RESUCITATE

n= 13 (87%)*

RESUCITATION PERFORMED

n = 5 (63%)

NO RESUCITATION

PERFORMEDn= 3 (38%)

RESUCITATION PERFORMED

n= 2 (100%)

NO RESUCITATION

PERFORMEDn= 0 (0 %)

RESUSCITATION PERFORMED

n= 6 (50%)

NO RESUCITATION PERFORMED

n= 6 (50%)

* p < 0.05


CONCLUSIONThis study shows that all four life-prolonging treatments that older people who prefer a treatment, a majority actually also received the treatment. In contrast, a considerable number of people who preferred not to be treated, received the treatment anyhow, especially for artificial respiration. Yet, people who preferred no treatment received no treatment more often than people with an unknown preference. This was confirmed in a multiple logistic regression on factors related to forgoing treatment. In conclusion, the study underlines that it is indeed usefull to make your preferences known.

* p < 0.05

KNOWN PREFERENCE FOR

ART. NUTRION AND FLUIDS

n=44

UNKNOWN PREFERENCE

n= 33*

YES, DO ADMINISTER ART. NUTRITION AND

FLUIDSn= 26 (59%)

NO, DO NOT ADMINISTER ART. NUTRITION AND

FLUIDSn= 18 (41%)

ART. NUTRITION AND FLUIDS

ADMINISTEREDn= 19 (59%)

NO NUTRITION AND FLUIDS





ADMINISTEREDn= 3 (12 %)





KNOWN PREFERENCES ANTIBIOTICS

n=43

UNKNOWN PREFERENCES ANTIBIOTICS

n=20*

YES, DO ADMINISTER

ANTIBIOTICSn= 38 (88%)*

NO, DO NOT ADMINISTER ANTIBIOTICS

n= 5 (12%)

ANTIBIOTICS ADMINISTERED

n = 15 (79%)

NO ANTIBIOTICS ADMINISTERED

n= 4 (21%)


n= 33 (90%)


n= 3 (10%)


n= 2 (40%)


n= 3 (60%)

KNOWN PREFERENCE IN

ARTIFICAL RESPIRATION

n=32

UNKNOWN PREFERENCE IN

ARTIFICIAL RESPIRATION

n=13*

YES, DO ARTIFICIAL RESPIRATEn= 24 (75%)*

NO, DO NOT ARTIFICIAL RESPIRATE

n= 8 (25%)

ARTIFICIAL RESPIRATION PERFORMED

n = 8 (67%)

NO ARTIFICIAL RESPIRATION PERFORMED

n= 4 (33%)

ARTIFICIAL RESPIRATION PERFORMEDn= 23 (100%)

NO ARTIFICIAL RESPIRATION

n= 0 (0%)

ARTIFICIAL RESPIRATION PERFORMED

n= 7 (88%)

NO ARTIFICIAL RESPIRATION

n= 1 (12%)

Pneumonia (n=63)


*for 1 person unknown if treatment was performed problems with eating and drinking (n=77) forgoing...

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