TY - JOUR
T1 - Elders' environs and their end-of-life preferences
AU - Gheorghe, Cristina
AU - Vazquez, Rodrigo
AU - Casanegra, Ana I.
AU - Argento, Vivian
AU - Dadu, Ramona
AU - Feng, Yan
AU - Amoateng-Adjepong, Yaw
AU - Manthous, Constantine A.
PY - 2011/1
Y1 - 2011/1
N2 - Hypothesis: Elders' predilections regarding end-of-life interventions vary with their living environs. Methods: Patients in 3 settings-assisted living/outpatient, skilled nursing facility (SNF), and acute hospitalization-were asked to complete a brief questionnaire. Results: A total of 269 patients who averaged 80.0 ± (SD) 8.1 years, 44% male, 70% white were studied. Eighty-five patients were outpatient elderly, 101 were hospitalized for acute illnesses, and 83 were interviewed in SNFs. Outpatients (44/85; 52%) and acutely ill inpatients (40/101; 40%) were more likely than patients residing in SNFs (19/81; 23%) to choose comfort care only (P = .047) for acute pneumonia requiring endotracheal intubation (ETI). Overall, 32% changed their choice for ETI, opting for comfort care only if acute pneumonia was followed by disposition to an SNF. However, ambulatory and acutely ill elderly patients were 3 times as likely as SNF patients to change from aggressive to comfort care if the most likely outcome was disposition to an SNF (P < .001). In multivariate regression models, age (>80), gender, number of lost ADLs (>2), and self-described quality of life were not associated with choosing comfort care instead of ETI, whereas place of residence (SNF versus home) was independently associated with choosing ETI (odds ratio = 3.5; 95%CI = 1.9-6.4). Similarly, those already living in an SNF were more likely to opt for remaining there for advancing dementia (odds ratio = 7.7; 95%CI = 3.8-15.8). However, choices for ETI did not coincide with choosing an SNF for advancing dementia. Conclusions: Elders residing in nursing homes were more likely than ambulatory patients to request invasive end-of-life care, a difference that was more pronounced when outcome required disposition to an SNF. These preferences were not dependent on patients' self-described disability or quality of life. This study suggests that qualitative outcomes matter to patients and their choices are associated with their place of residence.
AB - Hypothesis: Elders' predilections regarding end-of-life interventions vary with their living environs. Methods: Patients in 3 settings-assisted living/outpatient, skilled nursing facility (SNF), and acute hospitalization-were asked to complete a brief questionnaire. Results: A total of 269 patients who averaged 80.0 ± (SD) 8.1 years, 44% male, 70% white were studied. Eighty-five patients were outpatient elderly, 101 were hospitalized for acute illnesses, and 83 were interviewed in SNFs. Outpatients (44/85; 52%) and acutely ill inpatients (40/101; 40%) were more likely than patients residing in SNFs (19/81; 23%) to choose comfort care only (P = .047) for acute pneumonia requiring endotracheal intubation (ETI). Overall, 32% changed their choice for ETI, opting for comfort care only if acute pneumonia was followed by disposition to an SNF. However, ambulatory and acutely ill elderly patients were 3 times as likely as SNF patients to change from aggressive to comfort care if the most likely outcome was disposition to an SNF (P < .001). In multivariate regression models, age (>80), gender, number of lost ADLs (>2), and self-described quality of life were not associated with choosing comfort care instead of ETI, whereas place of residence (SNF versus home) was independently associated with choosing ETI (odds ratio = 3.5; 95%CI = 1.9-6.4). Similarly, those already living in an SNF were more likely to opt for remaining there for advancing dementia (odds ratio = 7.7; 95%CI = 3.8-15.8). However, choices for ETI did not coincide with choosing an SNF for advancing dementia. Conclusions: Elders residing in nursing homes were more likely than ambulatory patients to request invasive end-of-life care, a difference that was more pronounced when outcome required disposition to an SNF. These preferences were not dependent on patients' self-described disability or quality of life. This study suggests that qualitative outcomes matter to patients and their choices are associated with their place of residence.
KW - End-of-life
KW - Mechanical ventilation
KW - Nursing home
KW - Preferences
KW - Resuscitation
KW - Skilled nursing facility
UR - http://www.scopus.com/inward/record.url?scp=78650612442&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2009.12.090
DO - 10.1016/j.jamda.2009.12.090
M3 - Article
C2 - 21194655
AN - SCOPUS:78650612442
SN - 1525-8610
VL - 12
SP - 22
EP - 28
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 1
ER -