Factors influencing the use of intensive procedures at the end of life.
Factors influencing the use of intensive procedures at the end of life.
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DOI：
10.1111/jgs.13104
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发表时间：
2014-11
影响因子：
6.3
通讯作者：
Kelley AS
中科院分区：
文献类型：
--
作者：
Tschirhart EC;Du Q;Kelley AS
To examine patient and regional factors associated with the use of intensive medical procedures in the last six months of life. Retrospective cohort study. The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of older adults. 3,069 HRS decedents aged 66 years or older. Multivariable logistic regression was used to evaluate associations among patient and regional factors and receipt of five intensive procedures: intubation/mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral/parenteral nutrition, or cardiopulmonary resuscitation in the last 6 months of life. Approximately 18% of subjects (n=546) underwent at least one intensive procedure in the last six months of life. Characteristics significantly associated with lower odds of an intensive procedure included age 85–94 years, compared to 65–74 years (Adjusted Odds Ratio 0.67, 95% Confidence Interval 0.51–0.90); Alzheimer’s disease (0.71, 0.54–0.94); cancer (0.60, 0.43–0.85); nursing home residence (0.70, 0.50–0.97); and having an advance directive (0.71, 0.57–0.89). In contrast, living in a region with higher hospital care intensity and black race both doubled one’s odds of undergoing an intensive procedure (2.16, 1.48–3.13, and 2.02, 1.52–2.69, respectively). Both patient characteristics and regional practice patterns are important determinants of intensive procedure use in the last six months of life. The effect of non-clinical factors highlights the need to better align treatments with patient preferences.
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