Factors influencing the use of intensive procedures at the end of life
- Autores: Evan C. Tschirhart, Qingling Du, Amy S. Kelley
- Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 62, Nº. 11, 2014, págs. 2088-2094
- Idioma: inglés
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Resumen
Objectives: To examine individual and regional factors associated with the use of intensive medical procedures in the last 6 months of life.
Design: Retrospective cohort study.
Setting: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of older adults.
Participants: HRS decedents aged 66 and older (N = 3,069).
Measurements: Multivariable logistic regression was used to evaluate associations between individual and regional factors and receipt of five intensive procedures: intubation and mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last 6 months of life.
Results: Approximately 18% of subjects (n = 546) underwent at least one intensive procedure in the last 6 months of life. Characteristics significantly associated with lower odds of an intensive procedure included aged 85–94 (vs 65–74, adjusted odds ratio (AOR) = 0.67, 95% confidence interval (CI) = 0.51–0.90), Alzheimer's disease (AOR = 0.71, 95% CI = 0.54–0.94), cancer (AOR = 0.60, 95% CI = 0.43–0.85), nursing home residence (AOR = 0.70, 95% CI = 0.50–0.97), and having an advance directive (AOR = 0.71, 95% CI = 0.57–0.89). In contrast, living in a region with higher hospital care intensity (AOR = 2.16, 95% CI = 1.48–3.13) and black race (AOR = 2.02, 95% CI = 1.52–2.69) each doubled one's odds of undergoing an intensive procedure.
Conclusion: Individual characteristics and regional practice patterns are important determinants of intensive procedure use in the last 6 months of life. The effect of nonclinical factors highlights the need to better align treatments with individual preferences.
