Are Preferences for Aggressive Medical Treatment Associated with Healthcare Utilization in the Very Old?

Abstract

<b><i>Objectives:</i></b> To examine the relationship between end-of-life (EOL) treatment preferences and recent hospitalization or emergency department (ED) care in the very old. <b><i>Design:</i></b> Quarterly telephone follow-up of participants in the EOL in the Very Old cohort. <b><i>Setting:</i></b> The EOL in the Very Old Age cohort drew from 1403 participants in the Health, Aging, and Body Composition (Health ABC) study who were alive in year 15 of follow-up. 87.5% (<i>n</i> = 1227) were successfully recontacted and enrolled. <b><i>Participants:</i></b> Preferences for treatment at the EOL and reported hospital and ED use were examined for 1118 participants (18% involving proxy reports) over 6 months, 1021 (16% with proxy reports) over 12 months, and 945 (23% with proxy reports) over 18 months in 6-month intervals. <b><i>Measurements:</i></b> Preferences for eight EOL treatments, elicited once each year; hospitalization and ED use reported every six months. <b><i>Results:</i></b> Preferences for more aggressive treatment (endorsing ≥5 of 8 options) were not significantly associated with inpatient or ED treatment. Inpatient and ED treatment were not associated with changes in preferences for aggressive EOL treatment over 12 months. <b><i>Conclusion:</i></b> Alternative measures that tap attitudes toward routine care, rather than EOL treatment preferences, may be more highly associated with healthcare utilization.