Preferences for more aggressive medical treatment are not significantly associated with inpatient or ED treatment, according to a recent study.1

“Declines in hospitalization and increasing use of hospice may indicate greater concern by older adults to avoid aggressive care,” notes Steven M. Albert, PhD, MS, FGSA, the study’s lead author. Albert is the Philip B. Hallen Endowed Chair in Community Health and Social Justice at University of Pittsburgh.

Researchers analyzed preferences for treatment at the end of life, and reported hospital and ED use for 1,118 patients over a six-month period, 1,021 patients over a 12-month period, and 945 patients over an 18-month period.

“In this study, we did not see lower hospitalization or emergency department use in people reporting a preference for less aggressive care,” says Albert.

Likewise, a hospital admission or ED visit did not reduce patients’ interest in electing aggressive care in the future. This suggests that hospitalization or ED use in old age often is intermittent, unclear, or unplanned and not always in the hands of the older person.

“The person who falls, experiences syncope, or seems unresponsive may end up in the hospital, despite preferences to avoid aggressive medical care,” says Albert.

It’s possible that attitudes toward routine care, rather than end-of-life treatment preferences, may be more highly associated with healthcare utilization, the researchers concluded. “A useful approach, recommended by palliative care proponents, is more options for non-hospital care,” says Albert. This might include medical home visits or simply a phone consult.

“These alternatives seem reasonable in the case of the very old, in light of the harm hospitalization may cause,” says Albert.

REFERENCE

1. Albert SM, Lunney JR, Ye L, et al. Are preferences for aggressive medical treatment associated with healthcare utilization in the very old? J Palliat Med 2017 Mar 23. doi: 10.1089/jpm.2016.0284. [Epub ahead of print]

SOURCE

• Steven M. Albert, PhD, MS, FGSA, Philip B. Hallen Endowed Chair in Community Health and Social Justice, University of Pittsburgh. Phone: (412) 624-3102. Email: smalbert@pitt.edu.