Original Studies
Preferences for Cardiopulmonary Resuscitation Among Patients 80 Years or Older: The Views of Patients and Their Physicians

https://doi.org/10.1016/S1525-8610(04)70323-0Get rights and content

Objective

To describe the cardiopulmonary resuscitation (CPR) preferences of hospitalized patients aged 80 and older. To examine physicians’ perceptions of their patients’ preferences and agreement between patients’ and physicians’ preferences, estimation of prognosis, and assessment of quality of life.

Setting

Four academic hospitals.

Participants

Patients 80 years or older hospitalized between January 1993 and November 1994.

Measurements

Detailed clinical data were collected by chart review and interview. Patients and physicians were interviewed to determine their preferences for cardiopulmonary resuscitation (CPR). Agreement between patients and physicians was assessed using the kappa statistic, which measures agreement beyond chance.

Results

Of the 1266 patients studied, their median age was 85 years, and 61% were female. The majority (55%) of the 1010 patients with CPR preference information available desired CPR. Compared with patients, fewer physicians wanted CPR (36%) if they were in their patients’ condition. Agreement between patients’ preferences and physicians’ perceptions of these preferences was low (absolute agreement 63%, kappa = 0.21). Agreement was better between physicians’ perceptions of patients’ preferences and physicians’ desire for themselves if they were in their patients’ condition (66%, kappa = 0.36). Agreement between patients’ and physicians’ estimates of survival was only slight (46%, kappa = 0.10). The majority of the disagreement occurred when the physician's prognostic estimate was worse than the patient's.

Conclusions

The majority of hospitalized patients 80 years and older wanted CPR. When asked to imagine themselves in the same clinical situation as their patients, physicians were much less likely to want CPR and viewed CPR as undesirable for most patients. Physicians’ estimates of patients’ prognoses were less optimistic than patients’ estimates, raising the possibility that physicians’ knowledge of older patients’ poor outcomes from CPR explains their lack of enthusiasm about CPR for most patients 80 years and older.

Section snippets

Study Population

The study population consisted of subjects enrolled in the Hospitalized Elderly Longitudinal Project (HELP), a prospective study of the CPR preferences and decision making of hospitalized patients age 80 and older, their surrogate decision makers, and their physicians. HELP recruited patients 80 years and older admitted to one of four academic medical centers between January 1993 and November 1994. Patients were excluded from the study if they did not speak English; had sustained multiple

Study Sample

A total of 1266 patients with a median age of 85 were enrolled in the HELP study. Of the 673 patients who were unable to be interviewed, 417 had interview data from surrogates available. The characteristics of the 1266 patients in the HELP study are listed in Table 1, Table 2, Table 3. Most of the patients were white, widowed, and had an annual income of less than $11,000. The majority were admitted to the hospital for cardiovascular or cerebrovascular disease. Slightly more than half of the

Discussion

We found that the majority (55%) of hospitalized patients aged 80 and older wanted CPR. As expected, the percentage of patients desiring CPR was less than studies of younger populations. 1, 5 The high percentage of patients desiring CPR in this population of patients 80 years and older may be undesirable given the low CPR survival rates of older patients. Two retrospective studies of in-hospital CPR attempts found that in patients over the age of 70 between 14% and 31% of patients survived CPR

Conclusion

The majority of hospitalized patients 80 years and older wanted CPR. When asked to imagine themselves in the same situation as their older patients, physicians were much less likely to want CPR than their patients. Physicians’ knowledge of older patients’ poor outcomes from CPR may explain the fact that they viewed CPR as undesirable for most patients 80 years and older.

Acknowledgments

This research was supported 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. Ms. O'Donnell was supported by the American Federation of Aging Research Medical Student Geriatric Scholar Program. Dr. Hamel was supported by a Career Development Award from the National Institute on Aging (K08 AG0075–02) and the Paul Beeson

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    Copyright © 2003 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.