Illness severity, not age, predicts death in older sick people

November 14, 1999

Less aggressive care not the reason, Boston study finds

BOSTON--Age plays only a small role in the risk of short-term death among seriously ill people, according to a study published by researchers from Beth Israel Deaconess Medical Center in Boston and their colleagues. Instead, people who were the sickest had the highest risk of death, according to the report in the Nov. 16 issue of the Annals of Internal Medicine.

Surprisingly, the less aggressive care typically given to older people did not account for age-related differences in survival, says first author Mary Beth Hamel MD, a general internist at Beth Israel Deaconess and an instructor in medicine at Harvard Medical School.

"Some people assume, once patients reach their 70s or 80s, they have little chance of surviving a serious illness and that younger patients have a much greater chance" Hamel says. "While it's true that age is associated with worse outcomes, the effect is fairly modest. It's important to look at patients as individuals and not make generalizations about their ability to benefit from treatment based on their age."

In earlier reports from the same data, Hamel had shown that older patients receive less aggressive care. This study explored the link between less aggressive care and death rates. The findings suggest that less aggressive treatment for elderly patients may not account for shortened survival compared to younger patients.

In this study, after accounting for age-related differences in severity of illness and aggressiveness of care, each additional year of age increased the rate of death by about 1 percent. Another view of the numbers shows that 44 percent of severely ill patients aged 55 would be expected to die within six months, 48 percent of patients aged 65 would die within six months, 53 percent of patients aged 75, and 60 percent of patients aged 85.

Hamel and her colleagues analyzed data from 9,105 hospitalized patients in five teaching hospitals in Boston, Cleveland, Los Angeles, Marshfield, Wis., and Durham, N.C. Patients had one or more of nine common serious conditions, including heart failure, liver failure, lung failure, coma, or cancer. Patients ranged in age from 18 to 100, with an average age of 63. Overall, 44 percent were female, and 16 percent were black.

The data were originally gathered from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Better known as SUPPORT, the study data have formed the basis of more than 62 published articles that have highlighted the complex problems of medical care at the end of life, according to Steven Schroeder MD, president and CEO of the Robert Wood Johnson Foundation in Princeton, NJ, who wrote an accompanying editorial in the same issue.

The study was funded by the Robert Wood Johnson Foundation. Hamel also is supported by the National Institute on Aging.
-end-


Beth Israel Deaconess Medical Center

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