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.

Beth Israel Deaconess Medical Center

Related Internal Medicine Articles from Brightsurf:

COVID-19 news from Annals of Internal Medicine
In this Ideas and Opinions piece from the University of California, San Francisco and San Francisco Veterans Affairs Medical Center, the authors discuss the findings of early studies that addressed the use of chest computed tomography for the detection of COVID-19.

New COVID-19 content from Annals of Internal Medicine
Below please find links to new coronavirus-related content published today in Annals of Internal Medicine.

Changes in internal medicine subspecialty choices of women, men
This study used enrollment data to examine changes in the internal medicine subspecialty choices of women and men from 1991 to 2016.

Do internal medicine residents feel bullied during training?
This research letter uses survey data to report on perceived bullying by internal medicine residents during training.

Annals publishes annual updates in internal medicine
Annals of Internal Medicine, the flagship journal of the American College of Physicians (ACP), has published summaries of the most important medical studies published in 2016 in the fields of general internal medicine, cardiology, hematology, endocrinology, gastroenterology and hepatology, rheumatology, and perioperative, pulmonary, and geriatric medicine.

News from Annals of Internal Medicine April 7, 2015
In the next issue of Annals of Internal Medicine are: Weight Watchers and Jenny Craig come out on top among commercial weight loss programs; Physical therapy as effective as surgery for lumber spinal stenosis; and Leading internists call for more thoughtful use of CPR.

News from Annals of Internal Medicine March 31, 2015
Articles include: USPSTF reviews evidence to update recommendations on iron supplementation and deficiency screening in pregnant women; New hep C treatments are cost-effective for some patients, yet may exceed insurers' willingness to pay.

News from Annals of Internal Medicine March 24, 2015
The US Preventive Services Task Force concludes that the current evidence is insufficient to recommend for or against screening for thyroid dysfunction in nonpregnant, asymptomatic adults.

News from Annals of Internal Medicine Feb. 10, 2015
Using Lung Imaging Reporting and Data System (Lung-RADS) criteria developed by the American College of Radiology to interpret low-dose CT lung screening results may reduce false positives compared to the National Lung Screening Trial, but the trade-off is reduced sensitivity, according to an article published in Annals of Internal Medicine.

News from Dec. 23, 2014, Annals of Internal Medicine
The Dec. 23, 2014, issue of Annals of Internal Medicine includes 'Blood pressure drugs likely to prevent stroke and death in patients with mild hypertension' and 'Task force reviews evidence to update blood pressure screening recommendations.'

Read More: Internal Medicine News and Internal Medicine Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to