October 10, 1994

Changes in Decisions by Elderly Persons Based on Treatment Description

Author Affiliations

From the Department of Medicine (111), Kansas City (Mo) Veterans Affairs Medical Center (Dr Ainslie) and the Center on Aging and Department of Preventive Medicine, University of Kansas Medical Center (Dr Beisecker), Kansas City.

Arch Intern Med. 1994;154(19):2225-2233. doi:10.1001/archinte.1994.00420190129015

Background:  We examined hypotheses that elderly persons refusing minimally described treatment might choose nonaggressive treatment if options were described, and that persons refusing treatment would want an active decision-making role.

Methods:  One hundred fifty-one of 260 elderly volunteers recruited from 10 urban and suburban nutrition sites completed a self-administered questionnaire asking whether they would accept treatment of pneumonia in their current health status, in physical incapacity by stroke, or in early or late Alzheimer's disease. Subsequently, treatment choices ranging from oral antibiotics to ventilator use for severe pneumonia were described, and subjects again chose treatment for each situation. For each choice, subjects were asked who they wanted to make the decision.

Results:  One hundred sixteen subjects (75% women, 78% white) passed a comprehension quiz about pneumonia, stroke, and Alzheimer's disease. When asked to decide on treatment of pneumonia before descriptions of treatment, 1.8% refused treatment in their current state of health, 29.8% in stroke, and 41.3% and 65.7% in early and late Alzheimer's disease, respectively. When treatment choices ranging from oral antibiotics to ventilator treatment were offered, treatment refusal was significantly less in the comorbid situations at 21.7% for stroke, and 30.8% and 51.4% for early and late Alzheimer's disease. However, less aggressive treatment was not chosen more often by persons who had initially refused treatment. For each comorbidity more refusers than acceptors chose to be the decision maker.

Conclusions:  Elderly persons are more likely to refuse treatment in situations of severe comorbidities, but accept treatment more often when different options are explained. Refusers may want a strong role in the decision.(Arch Intern Med. 1994;154:2225-2233)