Abstract
Objectives
To determine how demographic, socioeconomic, health, and psychosocial factors predict
preferences to accept life-prolonging treatments (LPTs) at the end of life (EOL).
Methods
This is a retrospective cohort study of a nationally representative sample of community-dwelling
older Americans (N = 1648). Acceptance of LPT was defined as wanting to receive all LPTs in the hypothetical
event of severe disability or severe chronic pain at the EOL. Participants with a
durable power of attorney, living will, or who discussed EOL with family were determined
to have expressed their EOL preferences. The primary analysis used survey-weighted
logistic regression to measure the association between older adult characteristics
and acceptance of LPT. Secondarily, the associations between LPT preferences and health
outcomes were measured using regression models.
Results
Approximately 31% of older adults would accept LPT. Nonwhite race/ethnicity (odds
ratio [OR] 0.54; 95% CI 0.41, 0.70; white vs. nonwhite), self-realization (OR 1.34;
95% CI 1.01, 1.79), attendance of religious services (OR 1.44; 95% CI 1.07, 1.94),
and expression of preferences (OR 0.54; 95% CI 0.40, 0.72) were associated with acceptance
of LPT. LPT preferences were not independently associated with mortality or disability.
Conclusions
Approximately one-third of older Americans would accept LPT in the setting of severe
disability or severe chronic pain at the EOL. Adults who discussed their EOL preferences
were more likely to reject LPT. Conversely, minorities were more likely to accept
LPT. Sociodemographics, physical capacity, and health status were poor predictors
of acceptance of LPT. A better understanding of the complexities of LPT preferences
is important to ensuring patient-centered care.
Key Words
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Article info
Publication history
Published online: May 03, 2020
Accepted:
April 5,
2020
Identification
Copyright
© 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
