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Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study
Author(s) -
Straton Joseph B.,
Wang NaeYuh,
Meoni Lucy A.,
Ford Daniel E.,
Klag Michael J.,
Casarett David,
Gallo Joseph J.
Publication year - 2004
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2004.52165.x
Subject(s) - medicine , depression (economics) , confidence interval , late life depression , gerontology , odds ratio , checklist , quality of life (healthcare) , vignette , cohort , psychiatry , cognition , psychology , social psychology , nursing , economics , cognitive psychology , macroeconomics
(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.