We share the lack of surprise expressed by Boyd et al1 that the use of do-not-resuscitate (DNR) orders increases with age "even after the severity of illness is controlled as a confounding variable." Indeed, Boyd and colleagues' findings are consistent with those of a national sample of more than 14 000 hospitalized Medicare patients that previously showed that severity-adjusted DNR orders were 75% more likely to occur in patients older than 85 years than in patients younger than 75 years (14% vs 8%).2 We disagree, however, with their suggestion that the rate of DNR orders in the oldest age groups implies age discrimination by providers. In fact, we believe that there is considerable empirical evidence supporting the notion that higher rates of DNR orders represent provider responsiveness to elderly patients' own values and preferences, the hallmark of self-determination.
Inquiries into differences in cardiopulmonary resuscitation (CPR) preferences across age
Rosenfeld KE, Wenger NS. Do-Not-Resuscitate Orders in the Elderly: Age Discrimination or Patient Preference?. Arch Intern Med. 1997;157(9):1041-1043. doi:10.1001/archinte.1997.00440300163018