Many Elderly Patients Prefer Quantity to Quality of Life
Cincinnati--According to an article published in the February 4, 1998 issue of The Journal of the American Medical Association (JAMA), Joel Tsevat, MD, MPH, general internist and director of Outcomes Research in the University of Cincinnati (UC) College of Medicine, Department of Internal Medicine, and colleagues found that many patients aged 80 and older would prefer living as long as possible in their current state of health, rather than living a shorter life in excellent health. Elderly hospital patients (aged 80 and over) were interviewed by Tsevat and fellow researchers at the Beth Israel Deaconess Medical Center in Boston, the Cleveland MetroHealth Medical Center, the Marshfield Clinic at St. Joseph's Hospital in Wisconsin, and the University of California at Los Angeles Medical Center.
As a result of this study, physicians are urged to seek patients' preferences when deciding on aggressive medical treatment for the very old. Tsevat, research director of the UC Center for Clinical Effectiveness at the Institute for Health Policy and Health Services Research at UC, and his colleagues interviewed 414 elderly hospital patients (over 80-years-old) to assess their health values and compared these values to those from 300 of the surrogate decision-makers for these patients. The patients and their surrogate decision-makers were asked independently whether the patients would prefer living one year in the patient's current state of health, or less time in excellent health. The interviews were conducted four days alter the patients were hospitalized, and again 12 months later.
The researcher team did not intervene in the decisions about clinical care of these patients and noted that this patient study reflected a preference for current health relative to a shorter but healthier life. Tsevat and his colleagues reported that on average the patients equated living one year in their current state of health worth living only about ten months in excellent health. Although only approximately 30 percent of the patients rated their current quality of life as excellent or very good, and 69 percent were willing to give up no more than one month out of 12 in exchange for excellent health. At the other extreme, 6 percent were willing to live two weeks or less in excellent health rather than one year in their current state of health. Patients were willing to trade significantly less time for a healthy life than their family decision makers assumed they would. Patients willing to trade less time for better health were more likely to want resuscitation and other measures to extend life. Such patients also tended to rate their quality of life better and were less likely to be depressed.
When patients who survived were asked the time-tradeoff question again one year later, they were willing to trade less time for better health than when first asked. Tsevat says that the health values of very old hospitalized patients can be usually be taken directly from the patient.
The study concluded that because preferences vary so much and family decision makers cannot accurately gauge the health values of another person, health values of the very old should be elicited directly from the patient, whenever possible. This study was funded by a grant from the Robert Wood Johnson Foundation.