Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study

doi:10.1111/j.1532-5415.2004.52165.x

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Wiley InterScience

Journal of the American Geriatrics Society

Volume 52 Issue 4, Pages 577 - 582

Published Online: 30 Mar 2004

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

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Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study

Joseph B. Straton, MD, MSCE ^*† , Nae-Yuh Wang, PhD ^§ , Lucy A. Meoni, ScM ^†∥ , Daniel E. Ford, MD, MPH ^§¶# , Michael J. Klag, MD, MPH ^§¶# , David Casarett, MD, MA ^‡** and Joseph J. Gallo, MD, MPH ^*†

^* Department of Family Practice and Community Medicine , ^† Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology and ^‡ Division of Geriatrics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; ^§ Department of Medicine, School of Medicine, and Departments of ^∥ Biostatistics , ^¶ Epidemiology , and ^# Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland ; and ^** Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania.

Address correspondence to Joseph B. Straton, MD, MSCE, Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, PA 19104. E-mail: joseph.straton@uphs.upenn.edu

The Johns Hopkins Precursors Study was supported by Grant AG01760 from the National Institutes of Health, Bethesda, Maryland. Data analysis manuscript preparation was supported by Grant 1-D14-HP-000084 from the Health Resources and Services Administration and by a National Research Service Award AG00253-04 granted to Dr. Straton. Presented at the American Geriatrics Society annual meeting, Washington DC, May 2002.

KEYWORDS

decision-making • depression • quality of life • advance directives • resuscitation

ABSTRACT

(See editorial comments by Dr. Linda Emanuel on pp 641–642.)

Objectives: To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment.

Design: Mailed survey of older physicians.

Setting: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University.

Participants: Physicians who completed the life-sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n=645, 83% of respondents to the 1998 questionnaire; mean age 68).

Measurements: Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette.

Results: Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6-year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR)=2.14, 95% confidence interval (CI)=1.18–3.88) to prefer high-burden life-sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR=5.33, 95% CI=1.60–17.8) to prefer high-burden treatment than respondents without declining function or worsening depression.

Conclusion: This study calls attention to the need for clinical reassessment of preferences for potentially life-sustaining treatment when health has declined to prevent underestimating the preferences of older patients.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1532-5415.2004.52165.x About DOI