Stability over time in the preferences of older persons for life-sustaining treatment.

OBJECTIVE: To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. DESIGN: Longitudinal cohort study. SETTING: Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. RESULTS: 86 percent of the patients did not change preferences. Sex, age, marital status, hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. CONCLUSION: Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning.

[Life support treatment preferences in critical health situations]. / Preferencias de tratamiento de soporte vital en condiciones críticas de salud.

OBJECTIVE: To explore citizens' treatment preferences in critical health situations. METHOD: We performed a cross-sectional study through a questionnaire administered to 306 participants, randomly selected from nursing consultations, cultural centers, nursing homes and the university. Treatment preferences in critical health situations were measured through the Life Support Preferences Questionnaire (LSPQ). A descriptive bivariate and multivariate analysis was performed. RESULTS: The mean age of participants was 39.28 years (SD: 24.52), 37% had primary school or no education, and 29.1% were male. Age was inversely correlated with accepting treatments; thus acceptance of life support measures was lower among participants older than 55 years than among the youngest participants and was also lower among those with a lower educational level than those with a higher educational level. No differences were found between men and women. In serious diseases with no possibility of recovery, all age groups rejected treatment. When there was the potential for recovery or for non-invasive treatments, participants aged 21 years old or older would prefer to be treated. CONCLUSION: There is wide variability among the population when accepting or rejecting life support treatment. The view that treatment should be accepted at all costs is inappropriate. Disseminating knowledge of advance directives and the use of these documents is recommended as the most effective way to respect patients' wishes when they are unable to express themselves.