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Change of Health and Change of Preferences on Life-Sustaining Treatment: Evidence From a Longitudinal Study
Background: Decision-making for end-of-life (EoL) care is not a one-off choice. Older adults may change their preferences for life-sustaining treatments along their health continuum. Guided by prospect theory, we hypothesize that perceived change in health status is a driver behind preference change...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968987/ http://dx.doi.org/10.1093/geroni/igab046.069 |
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author | Lou, Yifan Bern-Klug, Mercedes Liu, Jinyu |
author_facet | Lou, Yifan Bern-Klug, Mercedes Liu, Jinyu |
author_sort | Lou, Yifan |
collection | PubMed |
description | Background: Decision-making for end-of-life (EoL) care is not a one-off choice. Older adults may change their preferences for life-sustaining treatments along their health continuum. Guided by prospect theory, we hypothesize that perceived change in health status is a driver behind preference changes. Method: Health and Retirement Study Wave 2012 to 2018 data. Sample is limited to 5,646 older adults who reported whether they requested to limit treatment in living will during two waves of data. Two possible preference changes were tested: from limited to default care and from default to limited care. Change in health status was indicated by changes (1=same, 2=improve, 3=decline) in physical pain, general health, activities of daily living, instrumental activities of daily living (IADL), and number of diagnoses. Multilevel logistic regression models were used to understand how change of health status was related to changes in EoL preferences. Results: 700 older adults changed their preferences some time in 8 years. Those who changed their preferences are more likely to be older and not married, and to have lower socioeconomic background. Older adults who experienced deteriorated pain levels were more likely to change their preferences from default to limited care (OR=3.77, p<.05) and less likely to change from limited to default care (OR=0.63, p<.05). Change in IADL is also a significant predictor of change of preferences. Implication: The findings highlight the importance of periodic reassessment of EoL care preferences with older adults. We discuss policy and practice implications regarding health changes as underlying mechanisms of preference changes. |
format | Online Article Text |
id | pubmed-8968987 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-89689872022-04-01 Change of Health and Change of Preferences on Life-Sustaining Treatment: Evidence From a Longitudinal Study Lou, Yifan Bern-Klug, Mercedes Liu, Jinyu Innov Aging Abstracts Background: Decision-making for end-of-life (EoL) care is not a one-off choice. Older adults may change their preferences for life-sustaining treatments along their health continuum. Guided by prospect theory, we hypothesize that perceived change in health status is a driver behind preference changes. Method: Health and Retirement Study Wave 2012 to 2018 data. Sample is limited to 5,646 older adults who reported whether they requested to limit treatment in living will during two waves of data. Two possible preference changes were tested: from limited to default care and from default to limited care. Change in health status was indicated by changes (1=same, 2=improve, 3=decline) in physical pain, general health, activities of daily living, instrumental activities of daily living (IADL), and number of diagnoses. Multilevel logistic regression models were used to understand how change of health status was related to changes in EoL preferences. Results: 700 older adults changed their preferences some time in 8 years. Those who changed their preferences are more likely to be older and not married, and to have lower socioeconomic background. Older adults who experienced deteriorated pain levels were more likely to change their preferences from default to limited care (OR=3.77, p<.05) and less likely to change from limited to default care (OR=0.63, p<.05). Change in IADL is also a significant predictor of change of preferences. Implication: The findings highlight the importance of periodic reassessment of EoL care preferences with older adults. We discuss policy and practice implications regarding health changes as underlying mechanisms of preference changes. Oxford University Press 2021-12-17 /pmc/articles/PMC8968987/ http://dx.doi.org/10.1093/geroni/igab046.069 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Abstracts Lou, Yifan Bern-Klug, Mercedes Liu, Jinyu Change of Health and Change of Preferences on Life-Sustaining Treatment: Evidence From a Longitudinal Study |
title | Change of Health and Change of Preferences on Life-Sustaining Treatment: Evidence From a Longitudinal Study |
title_full | Change of Health and Change of Preferences on Life-Sustaining Treatment: Evidence From a Longitudinal Study |
title_fullStr | Change of Health and Change of Preferences on Life-Sustaining Treatment: Evidence From a Longitudinal Study |
title_full_unstemmed | Change of Health and Change of Preferences on Life-Sustaining Treatment: Evidence From a Longitudinal Study |
title_short | Change of Health and Change of Preferences on Life-Sustaining Treatment: Evidence From a Longitudinal Study |
title_sort | change of health and change of preferences on life-sustaining treatment: evidence from a longitudinal study |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968987/ http://dx.doi.org/10.1093/geroni/igab046.069 |
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