Background.\p=m-\Engaging older persons in consideration of use of life-sustaining measures, such as cardiopulmonary resuscitation, tube feeding, and urgent intubation, is widely recommended, yet uncommon.Methods.\p=m-\Westudied the short-term impact of a physician-initiated discussion, geared toward guiding informed decision-making, with 20 frail elderly homebound patients. A battery of psychologic rating scales was administered in a pre-post design. Eighteen subjects completed the protocol. Fifteen of the mentally capable surviving subjects were reinterviewed 18 months following the initial discussion to evaluate durability of their decisions.Results.\p=m-\Mostwelcomed the discussion and clear choices regarding future care usually emerged. Depression rating scales decreased slightly for the entire sample. For the subgroup having relatively internal locus of control, there was an increase in life satisfaction scores. No patient demonstrated signs of emotional trauma consequent to the discussion. On follow-up, several patients were indecisive about their choices.Conclusion.\p=m-\Involvementof these patients in decisionmaking appeared to have no adverse effects, and, for some, it was therapeutic, possibly through enhancement of personal control. Durability of their decisions was not a consistent finding, however.Control over the use of life-sustaining interventions is the subject of intense controversy. Participants in the ongoing debate include physicians who feel that they un¬ derstand prognosis best, theorists who advocate for pa¬ tient self-determination, and public policy makers con¬ cerned with growing costs of care. Most agree that involvement by elderly persons in making decisions about their own fate is appropriate.Early communication with the elderly concerning ad-vanee directives has been recommended,1 yet such discus¬ sion remains an uncommon practice.
Previous age-related sense of control studies have largely focused on active, community-dwelling aged individuals and have excluded elderly persons who are frail. This study compares sense of control and life satisfaction as determined through rating scale administration between two frail, dependent samples: nursing home residents and homebound elderly. Differences in control scores were statistically significant for those who were homebound expressing higher perceived personal control than nursing home residents (p < .001). Sense of control has no correlation with either life satisfaction or length of stay in the nursing home cohort.
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