Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 May;27(5):568-75.
doi: 10.1007/s11606-011-1933-0. Epub 2011 Nov 30.

"Knowing is better": preferences of diverse older adults for discussing prognosis

Cyrus Ahalt  1 , Louise C Walter, Lindsey Yourman, Catherine Eng, Eliseo J Pérez-Stable, Alexander K Smith
Affiliations

"Knowing is better": preferences of diverse older adults for discussing prognosis

Cyrus Ahalt et al. J Gen Intern Med. 2012 May.

Abstract

Background: Prognosis is critical in individualizing care for older adults with late life disability. Evidence suggests that preferences for prognostic information may be culturally determined. Yet little is known about the preferences of diverse elders for discussing prognosis.

Objective: To determine the preferences for discussing prognosis of a diverse sample of older adults with late-life disability.

Design & participants: We interviewed 60 older adults with mean age 78 and mean 2.5 Activities of Daily Living dependencies. Participants were recruited from San Francisco's On Lok program, the first Program of All-inclusive Care for the Elderly (PACE). Participants were interviewed in English, Spanish, and Cantonese, and responded to scenarios in which their doctors estimated they had 5 years and 1 year left to live. Open-ended questions explored the reasons for their responses. Results were analyzed qualitatively using grounded theory.

Key results: Sixty-five percent of participants wanted to discuss the prognosis if their doctor estimated they had <5 years to live and 75% if the estimate was <1 year. Three themes were prominent among patients who wanted to discuss prognosis: to prepare, to make the most of the life they had left, and to make medical or health-related decisions. Those who preferred not to discuss prognosis described emotional difficulty, the uncertainty of prognosis, or that it would not be useful. Nearly all participants said that doctors should not make assumptions based on race or ethnicity, though differences between ethnic groups emerged.

Conclusions: Most patients in this diverse sample of disabled elders were interested in discussing prognosis, while a substantial minority was not. Among those participants who preferred to discuss prognosis, many said that prognostic information would be important as they made difficult medical and personal decisions in late-life. Clinicians should inquire about preferences for discussing prognosis before sharing prognostic estimates.

PubMed Disclaimer

References

    1. Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC. Prediction of mortality in community-living frail elderly people with long-term care needs. J. Am. Geriatr. Soc. 2008;56(1):68–75. doi: 10.1111/j.1532-5415.2007.01496.x. - DOI - PubMed
    1. Carey EC, Walter LC, Lindquist K, Covinsky KE. Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J. Gen. Intern. Med. 2004;19(10):1027–1033. doi: 10.1111/j.1525-1497.2004.40016.x. - DOI - PMC - PubMed
    1. Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med. Apr. 1997;12(4):203–208. - PMC - PubMed
    1. Fried LP, Kronmal RA, Newman AB, et al. Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. JAMA. 1998;279(8):585–592. doi: 10.1001/jama.279.8.585. - DOI - PubMed
    1. Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA. 1998;279(15):1187–1193. doi: 10.1001/jama.279.15.1187. - DOI - PubMed

Publication types