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Age differences in care practices and outcomes for hospitalized patients with cancer.

Publication ,  Journal Article
Rose, JH; O'Toole, EE; Dawson, NV; Thomas, C; Connors, AF; Wenger, NS; Phillips, RS; Hamel, MB; Cohen, HJ; Lynn, J
Published in: J Am Geriatr Soc
May 2000

OBJECTIVE: To identify age group differences in care practices and outcomes for seriously ill hospitalized patients with malignancy. DESIGN: Prospective cohort study (SUPPORT project). SETTING: Five United States teaching hospitals; data was gathered between 1989 and 1994. SUBJECTS: Nine hundred twenty five older (age > or = 65 years), 983 middle aged (age = 45-64 years), and 274 younger (age = 18-44 years) hospitalized patients receiving care for non-small cell lung cancer, colon cancer metastasized to the liver, or multi-organ system failure associated with malignancy. MEASUREMENTS: Care practices and patient outcomes were determined from hospital records. Length of survival was identified using the National Death Index. After adjusting for important variables, including severity of illness (i.e., SUPPORT model estimate for 2-month survival, cancer condition), hospital site, selection to intervention and sociodemographic variables, age group differences in care practices and outcomes were identified using general linear models. RESULTS: Older patients with cancer had lower resource utilization during hospitalization (P < .04) and were less likely to receive cancer-related treatments (i.e., chemotherapy, platelet infusions, scheduled intravenous medications) than middle-aged and young-adult patients in the first week of hospitalization (P < or = .01). More care topics were discussed with older patients and their families then with younger patients and their families (P < .001). Length of stay and total hospital costs were lower for older and middle-aged patients than for younger patients. Although more older patients had discussions about transfer to hospice (P < .001), older patients were no more likely to be discharged with supportive care (inpatient hospice or home with home/ hospice care). Older patients died sooner than middle-aged patients (P < .01). CONCLUSIONS: Patient age influenced care decisions and outcomes. Older patients (age > or = 65 years) received less aggressive care, had more discussions about care decisions, and died sooner than younger patients with cancer. Younger patients had longer stays, higher hospital costs, and greater probability of rehospitalization. Although well over half of patients died within 6 months of hospitalization, few patients in any age group were discharged with supportive care. Future studies should examine age differences in palliation, as well as acute care of cancer patients across inpatient and ambulatory care settings and should assess quality of care at the end of life.

Duke Scholars

Published In

J Am Geriatr Soc

DOI

ISSN

0002-8614

Publication Date

May 2000

Volume

48

Issue

S1

Start / End Page

S25 / S32

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Quality of Health Care
  • Prospective Studies
  • Multiple Organ Failure
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Liver Neoplasms
 

Citation

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Rose, J. H., O’Toole, E. E., Dawson, N. V., Thomas, C., Connors, A. F., Wenger, N. S., … Lynn, J. (2000). Age differences in care practices and outcomes for hospitalized patients with cancer. J Am Geriatr Soc, 48(S1), S25–S32. https://doi.org/10.1111/j.1532-5415.2000.tb03137.x
Rose, J. H., E. E. O’Toole, N. V. Dawson, C. Thomas, A. F. Connors, N. S. Wenger, R. S. Phillips, M. B. Hamel, H. J. Cohen, and J. Lynn. “Age differences in care practices and outcomes for hospitalized patients with cancer.J Am Geriatr Soc 48, no. S1 (May 2000): S25–32. https://doi.org/10.1111/j.1532-5415.2000.tb03137.x.
Rose JH, O’Toole EE, Dawson NV, Thomas C, Connors AF, Wenger NS, et al. Age differences in care practices and outcomes for hospitalized patients with cancer. J Am Geriatr Soc. 2000 May;48(S1):S25–32.
Rose, J. H., et al. “Age differences in care practices and outcomes for hospitalized patients with cancer.J Am Geriatr Soc, vol. 48, no. S1, May 2000, pp. S25–32. Pubmed, doi:10.1111/j.1532-5415.2000.tb03137.x.
Rose JH, O’Toole EE, Dawson NV, Thomas C, Connors AF, Wenger NS, Phillips RS, Hamel MB, Cohen HJ, Lynn J. Age differences in care practices and outcomes for hospitalized patients with cancer. J Am Geriatr Soc. 2000 May;48(S1):S25–S32.
Journal cover image

Published In

J Am Geriatr Soc

DOI

ISSN

0002-8614

Publication Date

May 2000

Volume

48

Issue

S1

Start / End Page

S25 / S32

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Quality of Health Care
  • Prospective Studies
  • Multiple Organ Failure
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Liver Neoplasms