Physical functioning, depression, and preferences for treatment at the end of life: the Johns Hopkins Precursors Study.

OBJECTIVES

To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment.

DESIGN

Mailed survey of older physicians.

SETTING

Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University.

PARTICIPANTS

Physicians who completed the life-sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n=645, 83% of respondents to the 1998 questionnaire; mean age 68).

MEASUREMENTS

Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette.

RESULTS

Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6-year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR)=2.14, 95% confidence interval (CI)=1.18-3.88) to prefer high-burden life-sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR=5.33, 95% CI=1.60-17.8) to prefer high-burden treatment than respondents without declining function or worsening depression.

CONCLUSION

This study calls attention to the need for clinical reassessment of preferences for potentially life-sustaining treatment when health has declined to prevent underestimating the preferences of older patients.