Withholding versus withdrawing life-sustaining treatment: patient factors and documentation associated with dialysis decisions.

Abstract:

OBJECTIVE:We evaluated prospectively the use of acute hemodialysis among hospitalized patients to identify demographic and clinical predictors of and chart documentation concerning dialysis withheld and withdrawn. DESIGN:Prospective cohort study. SETTING:Five teaching hospitals. PATIENTS:Five hundred sixty-five seriously ill hospitalized patients who had not previously undergone dialysis who developed renal failure. MAIN OUTCOME MEASURES:Patient demographics, clinical characteristics, preferences, and prognostic estimates associated with having dialysis withheld rather than initiated and withdrawn rather than continued. Differences in chart documentation concerning decision-making for dialysis withheld, withdrawn, and continued. RESULTS:Older patient age, cancer diagnosis, and male gender were associated with dialysis withheld rather than withdrawn. Age and gender differences persisted after adjustment for patients' aggressiveness of care preference. Worse 2-month prognosis was associated with both withholding and withdrawing dialysis. Chart documentation of decision-making was lacking more often for patients with dialysis withheld than for dialysis withdrawn. CONCLUSIONS:Measuring the equity of life-sustaining treatment use will require evaluation of care withheld, not just care withdrawn. Older patients and men, after accounting for prognosis and function, are more likely to have dialysis withheld than withdrawn after a trial. Further exploration is needed into this disparity and the inadequate chart documentation for patients with dialysis withheld.

journal_name

J Am Geriatr Soc

authors

Wenger NS,Lynn J,Oye RK,Liu H,Teno JM,Phillips RS,Desbiens NA,Sehgal A,Kussin P,Taub H,Harrell F,Knaus W

doi

10.1111/j.1532-5415.2000.tb03145.x

subject

Has Abstract

pub_date

2000-05-01 00:00:00

pages

S75-83

issue

S1

eissn

0002-8614

issn

1532-5415

journal_volume

48

pub_type

临床试验,杂志文章,多中心研究
  • Endothelial function in healthy younger and older hyperhomocysteinemic subjects.

    abstract:OBJECTIVES:To compare endothelium-dependent vasomotor response in healthy younger and older subjects without classic cardiovascular risk factors, with high and normal fasting homocysteine (tHcy) levels. DESIGN:We compared endothelium-dependent vasodilatation, using ultrasound, in healthy younger (aged 18-40) and older...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1046/j.1532-5415.2002.50255.x

    authors: Hirsch S,de la Maza P,Mendoza L,Petermann M,Glasinovic A,Paulinelli P,Barrera G,Rosenberg IH,Bunout D

    更新日期:2002-06-01 00:00:00

  • Value of neuropsychological tests, neuroimaging, and biomarkers for diagnosing Alzheimer's disease in younger and older age cohorts.

    abstract:OBJECTIVES:To examine the influence of age on the value of four techniques for diagnosing Alzheimer's disease (AD). DESIGN:Observational cohort study. SETTING:Alzheimer's Disease Neuroimaging Initiative. PARTICIPANTS:Individuals with mild cognitive impairment (MCI; n = 179), individuals with AD (n = 91), and normal ...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2011.03539.x

    authors: Schmand B,Eikelenboom P,van Gool WA,Alzheimer's Disease Neuroimaging Initiative.

    更新日期:2011-09-01 00:00:00

  • Effects of dehydroepiandrosterone supplementation on cognitive function and quality of life: the DHEA and Well-Ness (DAWN) Trial.

    abstract:OBJECTIVES:To examine the effects of dehydroepiandrosterone (DHEA) supplementation on cognitive function and quality of life in healthy older adults. DESIGN:Double-blind, randomized, controlled clinical trial. SETTING:Clinical research facility. PARTICIPANTS:One hundred ten men and 115 women aged 55 to 85 (mean +/- ...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1532-5415.2008.01768.x

    authors: Kritz-Silverstein D,von Mühlen D,Laughlin GA,Bettencourt R

    更新日期:2008-07-01 00:00:00

  • Treatment approaches with the psychiatric elderly.

    abstract::In reviewing the literature on treatment approaches with the psychiatric elderly, a large number of studies were found which espouse comprehensive rehabilitation programs that usually require supplementation of existing personnel and expansion of facilities. Although some agencies and institutions are fortunate in sec...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.1977.tb00648.x

    authors: Goga JA,Hambacher WO

    更新日期:1977-07-01 00:00:00

  • Effect of New Oral Anticoagulants on Prescribing Practices for Atrial Fibrillation in Older Adults.

    abstract:OBJECTIVES:To determine the effect of new oral anticoagulants (NOACs) on prescribing practices in older adults with atrial fibrillation (AF). DESIGN:Retrospective observational cohort study. SETTING:Academic medical center in St. Louis, Missouri. PARTICIPANTS:Individuals aged 75 and older with AF admitted to the hos...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/jgs.15058

    authors: Fohtung RB,Novak E,Rich MW

    更新日期:2017-11-01 00:00:00

  • Stroke prophylaxis in institutionalized elderly patients with atrial fibrillation.

    abstract:OBJECTIVES:To identify patterns and predictors of antithrombotic use and to evaluate the appropriateness of antithrombotic therapy for stroke prophylaxis in institutionalized elderly patients with atrial fibrillation. DESIGN:Retrospective study. SETTING:Seventeen long-term care institutions in Edmonton, Alberta. SUB...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2004.52117.x

    authors: Lau E,Bungard TJ,Tsuyuki RT

    更新日期:2004-03-01 00:00:00

  • Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study.

    abstract:OBJECTIVES:To determine the prevalence and outcomes of breathlessness in older Americans. SETTING:Community-dwelling older adults. PARTICIPANTS:Individuals aged 70 and older in the nationally representative Health and Retirement Study (2008, follow-up through 2012) (N = 3,671; mean age 78). MEASUREMENTS:Breathlessne...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/jgs.14313

    authors: Smith AK,Currow DC,Abernethy AP,Johnson MJ,Miao Y,Boscardin WJ,Ritchie CS

    更新日期:2016-10-01 00:00:00

  • Patterns of change in depression after stroke.

    abstract:OBJECTIVES:To provide estimates of change in depressive symptoms and determine how changes in depressive symptom influence recovery of functional status. DESIGN:Prospective cohort study. SETTING:Eleven inpatient medical rehabilitation facilities located across the United States. PARTICIPANTS:Five hundred forty-four ...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章,多中心研究

    doi:10.1111/j.1532-5415.2010.03266.x

    authors: Ostir GV,Berges IM,Ottenbacher A,Ottenbacher KJ

    更新日期:2011-02-01 00:00:00

  • Associations Between Inflammation and Physical Function in African Americans and European Americans with Prevalent Cardiovascular Risk Factors.

    abstract:OBJECTIVES:To examine associations between inflammation and physical function and potential mediation by white matter hyperintensities (WMHs) in African Americans (AAs) and European Americans (EAs). DESIGN:Cross-sectional analysis using linear and logistic models with generalized estimating equations to account for fa...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/jgs.14229

    authors: Windham BG,Wilkening SR,Lirette ST,Kullo IJ,Turner ST,Griswold ME,Mosley TH Jr

    更新日期:2016-07-01 00:00:00

  • Does Physician Retirement Affect Patients? A Systematic Review.

    abstract:OBJECTIVES:Older patients that have aged with their doctors will likely experience their physician retiring. It is unclear if this interruption in continuity of care leaves patients at risk for adverse events or whether a new physician improves care. We sought to identify and synthesize findings from all articles exami...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/jgs.16216

    authors: Lam K,Arnold CG,Savage RD,Stall NM,Zhu L,Wu W,Piggott K,Bronskill SE,Rochon PA

    更新日期:2020-03-01 00:00:00

  • The prevalence and correlates of major and minor depression in older medical inpatients.

    abstract:OBJECTIVES:To describe the prevalence of and characteristics associated with major and minor depression in older medical inpatients and to compare associated characteristics by sex and history of depression. DESIGN:Cross-sectional study of two patient samples, with and without a screening diagnosis of major or minor d...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2005.53404.x

    authors: McCusker J,Cole M,Dufouil C,Dendukuri N,Latimer E,Windholz S,Elie M

    更新日期:2005-08-01 00:00:00

  • Apolipoprotein E epsilon4, Alzheimer's disease, and cognitive performance in elderly Mexican Mestizos.

    abstract:OBJECTIVES:To determine the relationship between apolipoprotein E (APOE) epsilon4 and Alzheimer's disease (AD) in the Mexican Mestizo population, as well as its effects on the cognitive profile of AD and elderly Mestizos without dementia. DESIGN:Cross-sectional analysis of a cohort study. SETTING:Evaluations were con...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2007.01606.x

    authors: Villalpando-Berumen JM,Mejia-Arango S,Aguilar-Salinas CA,Ordonez-Sanchez ML,Gutierrez-Robledo LM

    更新日期:2008-04-01 00:00:00

  • An evaluative study of Silver's Cerebral Function Test.

    abstract::The aim of this study was to evaluate the usefulness of Silver's Cerebral Function Test in predicting the management and placement of patients admitted to a psychogeriatric hospital. Overall, 205 consecutively admitted patients and 54 age-matched controls living in the community were examined, thereby greatly extendin...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.1977.tb00409.x

    authors: Ross N,de L Horne DJ

    更新日期:1977-06-01 00:00:00

  • Use of self-report to predict ability to walk 400 meters in mobility-limited older adults.

    abstract:OBJECTIVES:To determine whether the ability to walk 400 m could be predicted from self-reported walking habits and abilities in older adults and to develop an accurate self-report measure appropriate for observational trials of mobility when functional measures are impractical to collect. DESIGN:Cross-sectional. SETT...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2004.52571.x

    authors: Sayers SP,Brach JS,Newman AB,Heeren TC,Guralnik JM,Fielding RA

    更新日期:2004-12-01 00:00:00

  • Longer Term Effects of Diet and Exercise on Neurocognition: 1-Year Follow-up of the ENLIGHTEN Trial.

    abstract:OBJECTIVES:To evaluate the longer term changes in executive functioning among participants with cardiovascular disease (CVD) risk factors and cognitive impairments with no dementia (CIND) randomized to a diet and exercise intervention. DESIGN:A 2 (Exercise) × 2 (Dietary Approaches to Stop Hypertension [DASH] eating pl...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/jgs.16252

    authors: Blumenthal JA,Smith PJ,Mabe S,Hinderliter A,Welsh-Bohmer K,Browndyke JN,Doraiswamy PM,Lin PH,Kraus WE,Burke JR,Sherwood A

    更新日期:2020-03-01 00:00:00

  • Urinary incontinence and its association with death, nursing home admission, and functional decline.

    abstract:OBJECTIVES:To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). DESIGN:A population-based prospective cohort study from 1993 to 1995. SETTING:Community-d...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2004.52207.x

    authors: Holroyd-Leduc JM,Mehta KM,Covinsky KE

    更新日期:2004-05-01 00:00:00

  • Gender differences in the behavioral manifestations of Alzheimer's disease.

    abstract:OBJECTIVE:To examine the relationship between gender and specific types of behavior problems that occur in patients with Alzheimer's disease. DESIGN:This was an observational study using the Dementia Behavior Disturbance Scale to quantify and define behavioral problems encountered by caregivers. Multiple regressions w...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.1996.tb01447.x

    authors: Ott BR,Tate CA,Gordon NM,Heindel WC

    更新日期:1996-05-01 00:00:00

  • Mild cognitive impairment is associated with poorer decision-making in community-based older persons.

    abstract:OBJECTIVE:To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and healthcare decision-making. DESIGN:Community-based epidemiological cohort study. SETTING:Communities throughout northeastern Illinois. PARTICIPANTS:Older persons without dementia from the Rush Memory and Agi...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/jgs.13346

    authors: Han SD,Boyle PA,James BD,Yu L,Bennett DA

    更新日期:2015-04-01 00:00:00

  • An alternative model in geriatric care.

    abstract::An analysis is presented of one long-term care facility's attempt to develop a comprehensive geriatric program including care of the patient in a hospital, a skilled nursing home, a day hospital, or a clinic for care of the ambulatory aged. The goal was to raise issues for debate and discussion, especially in terms of...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.1979.tb06130.x

    authors: Ingman SR,McDonald CA,Lusky R

    更新日期:1979-06-01 00:00:00

  • Healthcare proxies of nursing home residents with advanced dementia: decisions they confront and their satisfaction with decision-making.

    abstract:OBJECTIVES:To describe the medical decisions confronting healthcare proxies (HCPs) of nursing home (NH) residents with advanced dementia and to identify factors associated with greater decision-making satisfaction. DESIGN:Prospective cohort study. SETTING:Twenty-two Boston-area NHs. PARTICIPANTS:Three hundred twenty...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2009.02304.x

    authors: Givens JL,Kiely DK,Carey K,Mitchell SL

    更新日期:2009-07-01 00:00:00

  • Opiniones: end-of-life care preferences and planning of older Latinos.

    abstract:OBJECTIVES:To measure end-of-life (EOL) care preferences and advance care planning (ACP) in older Latinos and to examine the relationship between culture-based attitudes and extent of ACP. DESIGN:Cross-sectional interview. SETTING:Twenty-two senior centers in greater Los Angeles. PARTICIPANTS:One hundred forty-seven...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2010.02853.x

    authors: Kelley AS,Wenger NS,Sarkisian CA

    更新日期:2010-06-01 00:00:00

  • Chronic medical conditions and risk of fall injury events at home in older adults.

    abstract:OBJECTIVE:To evaluate the association between selected chronic medical conditions (CMCs) and fall injury events at home among community-dwelling older persons. DESIGN:Population-based case-control study. SETTING:The general community. PARTICIPANTS:Persons aged 65 and older living at home, excluding those using a whe...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.1997.tb01480.x

    authors: Herndon JG,Helmick CG,Sattin RW,Stevens JA,DeVito C,Wingo PA

    更新日期:1997-06-01 00:00:00

  • Age-related determinants of outcome after acute myocardial infarction: a dobutamine-atropine stress echocardiographic study.

    abstract:OBJECTIVES:To investigate the cause of worse survival in older patients after myocardial infarction (MI). DESIGN:Prospective 18-month and longer follow-up study of a cohort of 167 patients (mean age +/- standard deviation 58 +/- 12, including 71 aged >or=65) with acute MI for cardiac events, defined as cardiac death, ...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1046/j.1532-5415.2002.t01-1-50302.x

    authors: Smart S,Sagar K,Tresch D

    更新日期:2002-07-01 00:00:00

  • Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults.

    abstract:OBJECTIVES:To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years. DESIGN:Ten-year follow-up of a randomized, controlled single-blind trial (Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)) with three intervention groups and a no-contact control...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/jgs.12607

    authors: Rebok GW,Ball K,Guey LT,Jones RN,Kim HY,King JW,Marsiske M,Morris JN,Tennstedt SL,Unverzagt FW,Willis SL,ACTIVE Study Group.

    更新日期:2014-01-01 00:00:00

  • Patient-related predictors of rehabilitation use for community-dwelling older Americans.

    abstract:OBJECTIVE:To determine patient factors that predict use of physical or occupational therapy (PT/OT) services by elderly people. DESIGN:Time-series study of the relationship of PT/OT use to a variety of characteristics present at baseline. PARTICIPANTS:Eight-hundred nine community-dwelling men and women aged 65 and ol...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.1992.tb02131.x

    authors: Mayer-Oakes SA,Hoenig H,Atchison KA,Lubben JE,De Jong F,Schweitzer SO

    更新日期:1992-04-01 00:00:00

  • The effect of medicated chewing gums on oral health in frail older people: a 1-year clinical trial.

    abstract:OBJECTIVES:To determine the effects of a medicated chewing gum on the oral health of frail older people. DESIGN:A controlled, double-blind trial using three groups based on random allocation of residential homes. SETTING:Sixteen residential homes in West Hertfordshire, England. PARTICIPANTS:One hundred eleven dentat...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1046/j.1532-5415.2002.50355.x

    authors: Simons D,Brailsford SR,Kidd EA,Beighton D

    更新日期:2002-08-01 00:00:00

  • Type and intensity of activity and risk of mobility limitation: the mediating role of muscle parameters.

    abstract:OBJECTIVES:To investigate the association between different types of physical activity behavior and incident mobility limitation in older men and women and to examine whether muscle parameters mediate these associations. DESIGN:Cohort study with 4.5-year follow-up. SETTING:Metropolitan areas surrounding Pittsburgh, P...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1111/j.1532-5415.2005.53257.x

    authors: Visser M,Simonsick EM,Colbert LH,Brach J,Rubin SM,Kritchevsky SB,Newman AB,Harris TB,Health ABC Study.

    更新日期:2005-05-01 00:00:00

  • Potential underuse, overuse, and inappropriate use of antidepressants in older veteran nursing home residents.

    abstract:OBJECTIVES:To examine prevalence and resident- and site-level factors associated with potential underuse, overuse, and inappropriate use of antidepressants in older Veterans Affairs (VA) Community Living Center (CLC) residents. DESIGN:Longitudinal study. SETTING:One hundred thirty-three VA CLCs. PARTICIPANTS:Three t...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.2011.03522.x

    authors: Hanlon JT,Wang X,Castle NG,Stone RA,Handler SM,Semla TP,Pugh MJ,Berlowitz DR,Dysken MW

    更新日期:2011-08-01 00:00:00

  • The Boston FICSIT study: the effects of resistance training and nutritional supplementation on physical frailty in the oldest old.

    abstract::Research indicates that lower extremity muscle weakness in the elderly is consistently related to impaired mobility and fall risk. Reversible components of the muscle weakness of aging include underuse syndromes and undernutrition, both of which are prevalent in nursing home populations. The Boston FICSIT study is a n...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1111/j.1532-5415.1993.tb06714.x

    authors: Fiatarone MA,O'Neill EF,Doyle N,Clements KM,Roberts SB,Kehayias JJ,Lipsitz LA,Evans WJ

    更新日期:1993-03-01 00:00:00

  • Temperature lowering after iced water. Enhanced effects in the elderly.

    abstract::Oral temperature has long been used as a basis for clinical decisions. The ingestion of cold liquids such as iced water, which are frequently found at patients' bedsides or in clinic waiting areas, has been believed to potentially lower oral temperature readings. The degree and duration of this effect, however, has no...

    journal_title:Journal of the American Geriatrics Society

    pub_type: 杂志文章

    doi:10.1111/j.1532-5415.1986.tb04245.x

    authors: Sugarek NJ

    更新日期:1986-07-01 00:00:00