The Association Between Mild Cognitive Impairment Diagnosis and Patient Treatment Preferences : a Survey of Older Adults

© 2021. Society of General Internal Medicine..

BACKGROUND: Older patients (65+) with mild cognitive impairment (MCI) receive less guideline-concordant care for cardiovascular disease (CVD) and other conditions than patients with normal cognition (NC). One potential explanation is that patients with MCI want less treatment than patients with NC; however, the treatment preferences of patients with MCI have not been studied.

OBJECTIVE: To determine whether patients with MCI have different treatment preferences than patients with NC.

DESIGN: Cross-sectional survey conducted at two academic medical centers from February to December 2019 PARTICIPANTS: Dyads of older outpatients with MCI and NC and patient-designated surrogates.

MAIN MEASURES: The modified Life-Support Preferences-Predictions Questionnaire score measured patients' preferences for life-sustaining treatment decisions in six health scenarios including stroke and acute myocardial infarction (range, 0-24 treatments rejected with greater scores indicating lower desire for treatment).

KEY RESULTS: The survey response rate was 73.4%. Of 136 recruited dyads, 127 (93.4%) completed the survey (66 MCI and 61 NC). The median number of life-sustaining treatments rejected across health scenarios did not differ significantly between patients with MCI and patients with NC (4.5 vs 6.0; P=0.55). Most patients with MCI (80%) and NC (80%) desired life-sustaining treatments in their current health (P=0.99). After adjusting for patient and surrogate factors, the difference in mean counts of rejected treatments between patients with MCI and patients with NC was not statistically significant (adjusted ratio, 1.08, 95% CI, 0.80-1.44; P=0.63).

CONCLUSION: We did not find evidence that patients with MCI want less treatment than patients with NC. These findings suggest that other provider and system factors might contribute to patients with MCI getting less guideline-concordant care.

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:37

Enthalten in:

Journal of general internal medicine - 37(2022), 8 vom: 08. Juni, Seite 1925-1934

Sprache:

Englisch

Beteiligte Personen:

Levine, Deborah A [VerfasserIn]
Galecki, Andrzej T [VerfasserIn]
Plassman, Brenda L [VerfasserIn]
Fagerlin, Angela [VerfasserIn]
Wallner, Lauren P [VerfasserIn]
Langa, Kenneth M [VerfasserIn]
Whitney, Rachael T [VerfasserIn]
Nallamothu, Brahmajee K [VerfasserIn]
Morgenstern, Lewis B [VerfasserIn]
Reale, Bailey K [VerfasserIn]
Blair, Emilie M [VerfasserIn]
Giordani, Bruno [VerfasserIn]
Welsh-Bohmer, Kathleen Anne [VerfasserIn]
Kabeto, Mohammed U [VerfasserIn]
Zahuranec, Darin B [VerfasserIn]

Links:

Volltext

Themen:

Aging
Alzheimer’s
Cardiovascular disease
Health services research
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Anmerkungen:

Date Completed 16.06.2022

Date Revised 02.06.2023

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1007/s11606-021-06839-w

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM325151849