Interpreting Excess Mortality in a Prevention Trial for Older Adults

Patrick, Donald L.; Beresford, Shirley A.A.; Ehreth, Jenifer; Diehr, Paula; Picciano, Joseph F.; Durham, Mary; Grembowski, David

doi:10.1093/ije/24.supplement_1.s27

Cited by 15 publications

(23 citation statements)

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“…25 Similarly, in a study of 200 older adult high risk patients, the number of intervention participants receiving life-sustaining treatment was only half of that for the control participants. 26 On the other hand, another survey provided specific information on 14 seriously ill patients of whom five insisted that withdrawing life-sustaining treatment was to be permitted only in the event that there was no possibility of their recovery. 2 Although decisions on withdrawal of life-sustaining treatment must be considered very carefully, these surveys also suggest it is necessary to encourage patients to complete advance directives because education about end-of-life issues provided the older adult participants in the current study with the opportunity to consider their end-of-life preferences as both patients and community-dwelling adults.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of end-of-life education among community-dwelling older adults

Matsui

2010

Nurs Ethics

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The purpose of this study was to evaluate the effectiveness of an educational intervention regarding end-of-life discussion directed at older Japanese adults and their attitude to and acceptance of this intervention. A quasi-experimental design was used. A total of 121 older adults, aged 65 years and over, consented to participate. Data from 55 intervention and 57 control participants were used for the analysis. The intervention consisted of an education program comprising a video, a lecture using a handout, and discussion among participants. The control group received only the handout. Both groups were followed up after one month. The intervention group's attitude became more favorable towards advance directives, especially living wills (P = 0.024). In addition, their expression of preference for life-sustaining treatment by means of artificial nutrition was less at follow up, demonstrating that these older adults had become more autonomous (P = 0.008). There was greater acceptance of the intervention as a whole by the intervention group compared with the control group (P = 0.011). Although few participants overall completed living wills, at follow up twice as many in the intervention group had discussed end-of-life matters with family members and/or their physician.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of end-of-life education among community-dwelling older adults

Matsui

2010

Nurs Ethics

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“…The study was conducted by Patrick and associates between 1989 and 1993 and has been reported elsewhere (Durham et al, 1991;Grembowski et al, 1993;Patrick et al, 1995). The study was conducted by Patrick and associates between 1989 and 1993 and has been reported elsewhere (Durham et al, 1991;Grembowski et al, 1993;Patrick et al, 1995).…”

Section: Methodsmentioning

confidence: 95%

Quality Adjusted Life Years in Older Adults With Depressive Symptoms and Chronic Medical Disorders

Unützer¹,

Patrick

Diehr

et al. 2000

Int. Psychogeriatr.

175

116

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We used data from a4-year prospective study of 2,558 primary care patients age 65 and older in a large staff model health maintenance organization to examine the association of clinically significant depressive symptoms and eight other chronic medical conditions with quality adjusted life years (QALYs). We developed linear regression models to examine the association of clinically significant depressive symptoms as defined by a score of 16 or greater on the Center for Epidemiological Studies Depression Scale and eight common chronic medical disorders at baseline with QALYs over the 4-year study period. Estimates of QALYs were derived from Quality of Well-Being Scale scores at baseline, at 2-year follow-up, and at 4-year follow-up. Individuals with clinically significant depressive symptoms at baseline had signrficantly lower QALYs over the 4year study period thannondepressed subjects, even after adjusting for differences in age, gender, and the eight other chronic medical conditions. In terms of the entire study population, only arthritis and heart disease were more strongly associated with QALYs than depression.

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“…General health checks were not consistently associated with changes in mortality. In 13 randomized trials that evaluated mortality (Table 2), 12,[17][18][19][20][21][22][23][24][25][26][27][28] eleven reported no significant allcause mortality benefit. 11,12,[17][18][19][21][22][23][25][26][27] For example, in the South-East London Screening Study (n=7,229), adults age 40 to 64 who were invited to two multiphasic screening sessions over two years experienced no benefit in eight-year mortality (6% overall) 21 or nine-year mortality (results not reported).…”

Section: Mortalitymentioning

confidence: 99%

General Health Checks in Adult Primary Care: A Review

Liss¹,

Uchida²,

Wilkes

et al. 2021

Preprint

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Importance: General health checks (also known as general medical exams, periodic health evaluations, checkups, or wellness visits) to identify and prevent disease are extremely common in adult primary care. Although general health checks are often expected and advocated by patients, clinicians, payers, and health systems, others question their value. The current evidence was updated and recommendations provided for conducting general health checks in adults. Observations: Randomized trials and observational studies with control groups from prior systematic reviews and an updated literature review through December 2020 were included. Out of 19 included randomized trials (906 to 59,616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check and 7 evaluated annual health checks. All of 12 included observational studies (240 to 471,415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n=7,229), adults age 40 to 64 who were invited to two health checks over two years experienced no 8-year mortality benefit (6% overall). However, general health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. For example, in the OXCHECK trial (n=4121), fewer intervention participants exercised less than once per month (68% versus 71%). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advanced directives. Conclusions and Relevance: General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment; risk factor control, preventive service uptake, and patient-reported outcomes. Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection to primary care.

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Interpreting Excess Mortality in a Prevention Trial for Older Adults

Abstract: Advance directives contributed to excess deaths, indicating the success of the autonomy intervention.

Cited by 15 publications

References 0 publications

Effectiveness of end-of-life education among community-dwelling older adults

Effectiveness of end-of-life education among community-dwelling older adults

Quality Adjusted Life Years in Older Adults With Depressive Symptoms and Chronic Medical Disorders

General Health Checks in Adult Primary Care: A Review

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