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June 18, 1982

Intensive Treatment for the Elderly-Reply

Author Affiliations

Massachusetts General Hospital Boston

JAMA. 1982;247(23):3186. doi:10.1001/jama.1982.03320480013012

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In Reply.—  Dr Portnoi's description of our outlook as pessimistic is not warranted. Neither our study nor our personal opinions favor withholding medical resources from elderly patients. However, the finding of a 43% one-year mortality in the group aged 75 years and older is a sobering reminder of the need to evaluate the role of intensive care in the context of patients' own goals and in the framework of continuous care that Dr Portnoi has described so well.Both the observations and principal conclusions of Drs Knaus and Wagner are in substantial agreement with our own. We do not maintain that physicians are generally less aggressive in treating elderly patients. In fact, our most prominently reported finding was that the use of major life-support interventions in the ICU increased with patient age.We did find that the ratio of mean charges for nonsurvivors to survivors decreased with age and suggested