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Life-sustaining interventions in frail elderly persons. Talking about choices
F R Kellogg1, M Crain, J Corwin
1Department of Community Medicine, St Vincent's Hospital and Medical Center, New York, NY 10011.
Archives of Internal Medicine
|November 1, 1992
Summary
Discussions about life-sustaining treatments empower frail elderly patients, improving well-being without adverse effects. While decisions were welcomed, their long-term durability varied among participants.
Area of Science:
- Geriatrics
- Bioethics
- Palliative Care
Background:
- Discussing life-sustaining measures with older adults is recommended but rarely practiced.
- Frail, homebound elderly patients often lack engagement in end-of-life care decisions.
Purpose of the Study:
- To assess the short-term impact of physician-initiated discussions on informed decision-making for life-sustaining treatments.
- To evaluate the psychological effects and decision durability in frail elderly patients.
Main Methods:
- A pre-post design study involving 20 frail, homebound elderly patients.
- Psychological rating scales administered before and after a physician-led decision-making discussion.
- Follow-up interviews at 18 months for surviving, capable subjects to assess decision durability.
Main Results:
- Most patients welcomed the discussions, leading to clearer future care choices.
- Depression scores slightly decreased; life satisfaction increased in those with internal locus of control.
- No emotional trauma was observed; however, decision durability varied upon follow-up.
Conclusions:
- Involving frail elderly patients in decision-making for life-sustaining measures is safe and potentially therapeutic.
- Enhanced personal control may contribute to therapeutic benefits.
- The durability of patient decisions regarding future care requires further investigation.
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