End-of-Life Preferences of the 'Very Old'

Abstract

Background: Despite increasing longevity and numbers of ‘very old’ people (aged ≥85 years) and certainty of death, there is limited literature on end-of-life (EOL) preferences of ‘very old’ people, especially in Australia. This study has explored cardio-pulmonary resuscitation (CPR), life-prolonging treatment (LPT) and place of death (POD) preferences of ‘very old’ people in Queensland (Qld), with a Statement of Choices (SoC) (completed 2015-2021) and hospital use and POD of ‘very old’ decedents, with and without a SoC. Methods: CPR, LPT and POD preferences were extracted from 9555 SoCs. Hospital use and POD data of SoC decedents and matched controls were obtained from Qld Health Statistical Branch and analysed with IBM-SPSS v26 using tests and multinomial regressions (p<0.01). Results: Those who preferred no CPR or LPTs (81.9% and 84.5% respectively) were more likely to be female (CPR:2(2)=22.2;LPT:2(2)=24.7), older (CPR:2(6)=71.6;LPT:2(6)=47.6), live in residential aged care facilities (RACFs) (CPR:2(6)=268.1;LPT:2(6)=142.8) and to have lost decision-making capacity (CPR:2(2)=85.6;LPT:2(2)=36.7) (p<0.001). Increasing age reduced odds (0.931) of these collinear characteristics (p<.001,OR.911-.952,CI99%). RACF was the most preferred POD ((12)=2414.1,p<.001,N=8986). Thematic review of preferences focussed on maximising quality of life and a comfortable death. 100% with no SoC and 60% with SoC had ≥1 hospital admission in last 6 months of life (5- and 2- day median cumulative length of stay) while 60% and 32% of ‘very old’ decedents died in hospital respectively (2(1),=436.2,p<.001,N=5890). Conclusion: While unique preferences should be respected, this research demonstrated that most ‘very old’ people would prefer to forgo interventions that prolong life, particularly if they negatively impact quality of life. They preferred EOL care in their home or RACF. A SoC reduced hospital use and hospital death in this cohort

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