Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults

Background: Patient age may influence decisions to withhold life-sustaining treatments, independent of patients' preferences for or ability to benefit from such treatments. Controversy exists about the appropriateness of usin g age as a criterion for making treatment decisions. Objective: To determine the effect of age on decisions to withhold life-sus taining therapies. Design: Prospective cohort study. Setting: Five medical centers participating in the Study to Understand Prog noses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Patients: 9105 hospitalized adults who had one of nine illnesses associated with an average 6-month mortality rate of 50%. Measurements: Outcomes were the presence and timing of decisions to withhol d ventilator support, surgery, and dialysis. Adjustment was made for sociod emographic characteristics, prognoses, baseline function, patients' prefere nces for life-extending care, and physicians' understanding of patients' pr eferences for life-extending care. Results: The median patient age was 63 years; 44% of patients were women, a nd 53% survived to 180 days. In adjusted analyses, older age was associated with higher rates of withholding each of the three life-sustaining treatme nts studied. For ventilator support, the rate of decisions to withhold ther apy increased 15% with each decade of age (hazard ratio, 1.15 [95% CI, 1.12 to 1.19]); for surgery, the increase per decade was 19% (hazard ratio, 1.1 9 [CI, 1.12 to 1.27]); and for dialysis, the increase per decade was 12% (h azard ratio, 1.12 [CI, 1.06 to 1.19]). Physicians underestimated older pati ents' preferences for life-extending care; adjustment for this underestimat ion resulted in an attenuation of the association between age and decisions to withhold treatments. Conclusion: Even after adjustment for differences in patients' prognoses an d preferences, older age was associated with higher rates of decisions to w ithhold ventilator support, surgery, and dialysis.