Clinical decision making in the care of the aged

This study examines the decision-making process of health care providers working with older patients. Data were obtained through telephone interviews from a random sample of 251 health care providers at three Veterans Administration medical centers. Responding to a hypothetical clinical vignette, the majority of providers chose to give the one remaining bed in an ICU to a younger versus an older patient. Individuals relied on the patient's expected quality of life as well as the medical risk to the patient as important factors in this decision. In another vignette, less than 15% of the sample strongly supported a life-prolonging intervention for an 85-year-old man whose obstructive pulmonary disease had taken a terminal course. Expected quality of life was the most important determinant of the decision not to intubate. Respondents of different professions consistently ranked DNR orders as the decision with which they were most comfortable and termination of life supports as the decision with which they were least comfortable. A discussion of the different medical, social, and institutional factors that influence decision making is provided.