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Does it Matter Who Decides? Outcomes of Surrogate Decision-Making for Community-Dwelling, Cognitively Impaired Older Adults Near the End of Life.
Baum, Micah Y; Gallo, Joseph J; Nolan, Marie T; Langa, Kenneth M; Halpern, Scott D; Macis, Mario; Nicholas, Lauren Hersch.
Afiliação
  • Baum MY; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
  • Gallo JJ; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
  • Nolan MT; Johns Hopkins School of Nursing, Baltimore, Maryland.
  • Langa KM; University of Michigan Institute for Social Research, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan.
  • Halpern SD; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
  • Macis M; Johns Hopkins Carey Business School, Baltimore, Maryland; Johns Hopkins School of Medicine, Baltimore, Maryland.
  • Nicholas LH; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; University of Michigan Institute for Social Research, Ann Arbor, Michigan; Johns Hopkins School of Medicine, Baltimore, Maryland; Colorado School of Public Health, Aurora, Colorado. Electronic address: lauren.h.nicholas@cuanschutz
J Pain Symptom Manage ; 62(6): 1126-1134, 2021 12.
Article em En | MEDLINE | ID: mdl-34153462
CONTEXT: Cognitively impaired older adults frequently need surrogate decision-making near the end-of-life. It is unknown whether differences in the surrogate's relationship to the decedent are associated with different end-of-life treatment choices. OBJECTIVES: To describe differences in end-of-life care for community dwelling, cognitively impaired older adults when children and spouses are involved in decision-making. METHODS: Retrospective observational study. RESULTS: Among 742 community-dwelling adults with cognitive impairment (mild cognitive impairment or dementia) prior to death, children participated in end-of-life decisions for 615 patients (83%) and spouses participated in decisions for 258 patients (35%), with both children and spouses participating for 131 patients (18%). When controlling for demographic characteristics, decedents with only a spouse decision-maker were less likely to undergo a life-sustaining treatment than decedents with only children decision-makers (P < 0.05). There was no difference in the probability of in-hospital death or burdensome transfers across facilities across decedent-decision-maker relationships. Differences in rates of life-sustaining treatment were greater when we restricted to decedents with dementia. CONCLUSION: Decedents with cognitive impairment or dementia were less likely to receive life-sustaining treatments when spouses versus children were involved with end-of-life treatment decisions but were no less likely to experience other measures of potentially burdensome end-of-life care.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Assistência Terminal / Vida Independente Tipo de estudo: Observational_studies / Prognostic_studies Limite: Aged / Child / Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Assistência Terminal / Vida Independente Tipo de estudo: Observational_studies / Prognostic_studies Limite: Aged / Child / Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article