ARE CRITICALLY ILL OLDER PATIENTS TREATED DIFFERENTLY THAN SIMILARLY ILL YOUNGER PATIENTS

Our goal was to determine whether critically ill older patients are tr eated differently than middle-aged patients. If so, what factors besid es age contribute to that difference? Internal medicine residents (n = 46) and practicing internists (n = 41) received 8 clinical vignettes of 4 critically ill 85-year-old patients and 4 critically ill 50-year- old patients. Each patient had a distinct premorbid mental and physica l state. Each respondent selected from 4 levels of therapeutic aggress iveness for each patient. The main outcome measure was the proportion of physicians who intended to treat the older of each matched pair of patients less aggressively than the younger one (that is, downgraded f or age). Eight physicians (9%) treated a previously unimpaired 85-year -old patient less aggressively than a comparable 50-year-old patient. When the matched patients were either premorbidly mentally or physical ly impaired (but not both), about 20% of physicians downgraded for age . Most downgraded for age in matched patients who were premorbidly bot h mentally and physically impaired, We conclude that age alone does no t engender much therapeutic bias against older patients as long as the y are physically and mentally intact before the onset of their acute i llness. As premorbid disabilities multiply, older patients may be trea ted less aggressively than younger ones with similar impairments and c linical presentations.