Poor decision making is associated with an increased risk of mortality among community-dwelling older persons without dementia

Abstract

Background: Decision making is thought to be an important determinant of health and well-being across the lifespan, but little is known about the association of decision making with mortality.

Methods: Participants were 675 older persons without dementia from the Rush Memory and Aging Project, a longitudinal cohort study of aging. Baseline assessments of decision making were used to predict the risk of mortality during up to 4 years of follow-up.

Results: The mean score on the decision making measure at baseline was 7.1 (SD = 2.9, range: 0-12), with lower scores indicating poorer decision making. During up to 4 years of follow-up (mean = 1.7 years), 40 (6% of 675) persons died. In a proportional hazards model adjusted for age, sex and education, the risk of mortality increased by about 20% for each additional decision making error (HR = 1.19, 95% CI = 1.07-1.32, p = 0.002). Thus, a person who performed poorly on the measure of decision making (score = 3, 10th percentile) was about 4 times more likely to die compared to a person who performed well (score = 11, 90th percentile). Further, the association of decision making with mortality persisted after adjustment for the level of cognitive function.

Conclusion: Poor decision making is associated with an increased risk of mortality in old age even after accounting for cognitive function.

Figure 1

Cumulative hazard of mortality for participants with poor (dotted line) vs. good (solid line) decision making derived from a model adjusted for age, sex and education.