The Johns Hopkins Precursors Study was supported by Grant AG01760 from the National Institutes of Health, Bethesda, Maryland. Data analysis manuscript preparation was supported by Grant 1-D14-HP-000084 from the Health Resources and Services Administration and by a National Research Service Award AG00253-04 granted to Dr. Straton. Presented at the American Geriatrics Society annual meeting, Washington DC, May 2002.
Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study
Article first published online: 30 MAR 2004
Journal of the American Geriatrics Society
Volume 52, Issue 4, pages 577–582, April 2004
How to Cite
Straton, J. B., Wang, N.-Y., Meoni, L. A., Ford, D. E., Klag, M. J., Casarett, D. and Gallo, J. J. (2004), Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study. Journal of the American Geriatrics Society, 52: 577–582. doi: 10.1111/j.1532-5415.2004.52165.x
- Issue published online: 30 MAR 2004
- Article first published online: 30 MAR 2004
- quality of life;
- advance directives;
(See editorial comments by Dr. Linda Emanuel on pp 641–642.)
Objectives: To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment.
Design: Mailed survey of older physicians.
Setting: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University.
Participants: 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).
Measurements: Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette.
Results: 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.
Conclusion: 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.