Depression, hopelessness, and the desire for life-saving treatments among elderly medically ill veterans

During a serious medical illness, several factors, including perceived qual ity of life, social support, functional disability, severity of illness, an d presence of depressive symptoms, influence desire for li,fe-saving treatm ents such as cardiopulmonary resuscitation (CPR), mechanical ventilation, t ube feeding, and intravenous fluids. The authors examined the influence of depression and hopelessness on preferences for life-saving treatment in old er medically ill male patients in the medical service of a Veterans Adminis tration Medical Center Subjects with high levels of hopelessness desired le ss life-saving treatment during their current illness; they were at least f ive times more likely to refuse CPR if required during the current hospital ization. This effect remained statistically significant after removing conf ounds of race, education, and religiosity. The diagnosis of major depressio n did not significantly influence the desire for life-saving treatment. Our findings suggest that psychiatrists should assess patients for severity of hopelessness when evaluating decision-making capacity in the context of in tervention refusal.