Factors influencing the use of intensive procedures at the end of life.

TitleFactors influencing the use of intensive procedures at the end of life.
Publication TypeJournal Article
Year of Publication2014
AuthorsTschirhart, EC, Du, Q, Kelley, A
JournalJ Am Geriatr Soc
Date Published2014 Nov
ISSN Number1532-5415
KeywordsAdvance directives, Aged, Aged, 80 and over, Alzheimer disease, Cause of Death, Chronic disease, Critical Care, Female, Homes for the Aged, Humans, Life Support Care, Logistic Models, Male, Multivariate Analysis, Neoplasms, Nursing homes, Odds Ratio, Terminal Care, United States, Utilization Review

OBJECTIVES: To examine individual and regional factors associated with the use of intensive medical procedures in the last 6 months of life.

DESIGN: Retrospective cohort study.

SETTING: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of older adults.

PARTICIPANTS: HRS decedents aged 66 and older (N = 3,069).

MEASUREMENTS: Multivariable logistic regression was used to evaluate associations between individual and regional factors and receipt of five intensive procedures: intubation and mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last 6 months of life.

RESULTS: Approximately 18% of subjects (n = 546) underwent at least one intensive procedure in the last 6 months of life. Characteristics significantly associated with lower odds of an intensive procedure included aged 85-94 (vs 65-74, adjusted odds ratio (AOR) = 0.67, 95% confidence interval (CI) = 0.51-0.90), Alzheimer's disease (AOR = 0.71, 95% CI = 0.54-0.94), cancer (AOR = 0.60, 95% CI = 0.43-0.85), nursing home residence (AOR = 0.70, 95% CI = 0.50-0.97), and having an advance directive (AOR = 0.71, 95% CI = 0.57-0.89). In contrast, living in a region with higher hospital care intensity (AOR = 2.16, 95% CI = 1.48-3.13) and black race (AOR = 2.02, 95% CI = 1.52-2.69) each doubled one's odds of undergoing an intensive procedure.

CONCLUSION: Individual characteristics and regional practice patterns are important determinants of intensive procedure use in the last 6 months of life. The effect of nonclinical factors highlights the need to better align treatments with individual preferences.


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Endnote Keywords

end-of-life decisions/terminal care/intensive care/Medicare/Advance Directives/regional variations/MEDICARE EXPENDITURES/SUSTAINING TREATMENTS/PATIENT PREFERENCES

Endnote ID


Alternate JournalJ Am Geriatr Soc
Citation Key8125
PubMed ID25376084
PubMed Central IDPMC4241150
Grant ListK23 AG040774 / AG / NIA NIH HHS / United States
1K23AG040774-01A1 / AG / NIA NIH HHS / United States