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Older Age, Aggressiveness of Care, and Survival for Seriously Ill, Hospitalized Adults

Mary Beth Hamel, MD, MPH; Roger B. Davis, ScD; Joan M. Teno, MD, MS; William A. Knaus, MD; Joanne Lynn, MD; Frank Harrell Jr., PhD; Anthony N. Galanos, MD; Albert W. Wu, MD, MPH; Russell S. Phillips, MD, SUPPORT Investigators
[+] Article, Author, and Disclosure Information

From Beth Israel Deaconess Medical Center, Boston, Massachusetts; Brown University, Providence, Rhode Island; University of Virginia School of Medicine, Charlottesville, Virginia; Center to Improve Care of the Dying, George Washington University, Washington, D.C.; Duke University Medical Center, Durham, North Carolina; and Johns Hopkins University, Baltimore, Maryland.

Presented in part at the National Meeting of the Society of General Internal Medicine, Washington, D.C., April 1994.

Grant Support: By the Robert Wood Johnson Foundation. The opinions and findings contained in this manuscript are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or their Board of Trustees. Dr. Hamel is supported by a Career Development Award from the National Institute on Aging (K08 AG0075-02).

Requests for Reprints: Mary Beth Hamel, MD, MPH, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Hamel, Davis, and Phillips: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.

Dr. Teno: Center for Gerontology and Health Care Research, Brown University, Box GB-219, 171 Meeting Street, Providence, RI 02912.

Drs. Knaus and Harrell: Department of Health Evaluation Sciences, University of Virginia School of Medicine, Box 600, Charlottesville, VA 22908.

Dr. Lynn: Center to Improve Care for the Dying, 2175 K Street NW, Suite 820, Washington, DC 20037.

Dr. Galanos: Division of Geriatrics, Duke University Medical Center, 353—Blue Zone, Durham, NC 27710.

Dr. Wu: Health Service Research and Development Center, Johns Hopkins University, 624 North Broadway, Baltimore, MD 21205.

Ann Intern Med. 1999;131(10):721-728. doi:10.7326/0003-4819-131-10-199911160-00002
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Compared with younger patients with illness of similar severity, seriously ill elderly patients receive fewer procedures, fewer life-sustaining treatments, and hospital care that is less costly (12). Numerous investigations have found that older patients tend to have poorer outcomes of serious illness and invasive procedures (36). None of these studies, however, has considered age-related differences in treatment strategies as a potential contributor to better outcomes for younger patients.

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Adjusted 6-month mortality according to patient age.solid line

The dashed line represents mortality estimates adjusted for sex, ethnicity, income, severity of illness, and baseline functional status. The solid line represents mortality estimates adjusted for sex; ethnicity; income; severity of illness; baseline functional status; treatment intensity; do-not-resuscitate orders on study day 1; and decisions to withhold transfer to intensive care unit, major surgery, dialysis, blood transfusion, vasopressor therapy, and tube feeding. The curves are anchored at the cohort's 6-month mortality rate (47%) for a patient of the cohort's mean age (63 years). The bars at ages 30, 50, 70, and 90 years represent 95% CIs for the mortality estimates adjusted for both severity and treatment ( ).

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Summary for Patients

Age, Intensity of Treatment, and Surviving Serious Illness

The summary below is from the full report titled “Older Age, Aggressiveness of Care, and Survival for Seriously Ill, Hospitalized Adults.” It is in the 16 November 1999 issue of Annals of Internal Medicine (volume 131, pages 721-728). The authors are M.B. Hamel, R.B. Davis, J.M. Teno, W.A. Knaus, J. Lynn, F. Harrell Jr., A.N. Galanos, A.W. Wu, and R.S. Phillips, for the SUPPORT Investigators.


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