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Age, Intensity of Treatment, and Surviving Serious Illness FREE

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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.

Ann Intern Med. 1999;131(10):721. doi:10.7326/0003-4819-131-10-199911160-00040
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What is the problem and what is known about it so far?

When they have a serious illness, older people tend to do worse than younger ones do. Some people think this may be, in part, because older people tend to get less intense treatment than younger ones.

Why did the researchers do this particular study?

The researchers wanted to examine the link between age and the likelihood of surviving a major illness. They wanted to see if the intensity of treatment played a role in this relationship.

Who was studied?

The researchers studied 9105 patients who were hospitalized with a serious illness, including heart failure, liver failure, lung failure, or cancer. To be in the study, patients had to have 50% chance of surviving for 6 months. The study was done at five teaching hospitals in Boston, Massachusetts; Los Angeles, California; Marshfield, Wisconsin; Durham, North Carolina; and Cleveland, Ohio.

How was the study done?

With patients' permission, the researchers collected detailed information from medical records. They also recorded whether patients were alive 6 months later by reviewing medical records and death records and by contacting patients, their families, and their doctors. The researchers analyzed this information to examine the relationship between age and being alive at 6 months while accounting for other important factors, such as the patient's social status, sex, ability to care for themselves before they got sick, and the severity of the illness.

What did the researchers find?

As expected, just over half of the study patients were alive 6 months later. The older a patient was, the more likely he or she was to die. A 55 year-old patient had a 44% chance of being dead 6 months later. The chances of dying within 6 months of the serious illness increases as people get older: 48% for 65-year-olds, 53% for 75-year-olds, and 60% for 85-year-olds. The thing that best predicted who would die was how sick the patient was at the time they entered the study. The less intense treatment given to older patients did not explain why they did worse.

What were the limitations of the study?

This study could not explain exactly why older persons did worse.

What are the implications of the study?

The most important factor in how well a person does when they have a serious illness is the level of sickness. In general, however, older persons do a little worse than younger ones who are just as sick. Less-intense treatment for older persons does not appear to be the reason older persons do worse.





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