INTERPRETING EXCESS MORTALITY IN A PREVENTION TRIAL FOR OLDER ADULTS

Background. In a randomized trial evaluating preventive services for o lder adults excess mortality was observed in the treatment group. We e xamined four explanations: unbalance of baseline characteristics, unin tended effects of the intervention, consequence of an autonomy interve ntion (including increased number of living wills in the treatment gro up), and chance. We focus here on the effects of the autonomy interven tion. Methods. Preparation of living wills in the treatment and contro l groups was compared both at baseline and follow-up. A linear predict or of mortality was used to identify participants at high risk of dyin g. Charts of these 200 participants were reviewed for evidence of seri ous medical events and resuscitation decisions. Rates of life-sustaini ng treatment were compared between treatment and controls using logist ic regression. Results. More living wills (65%) were noted for the tre atment group than control group (47%) at follow-up. Thirty-six per cen t of participants were identified as having a serious medical event; o f these, participants in the treatment group were over twice as likely not to receive life-sustaining treatment. Conclusions. Advance direct ives contributed to excess deaths, indicating the success of the auton omy intervention.