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Study shows proxies are less likely to use burdensome interventions when they believe patients with advanced dementia are nearing end of life.

BOSTON — Researchers from Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research have discovered that to begin with, proxies are a fairly accurate judge of the length of life left for their loved one with advanced dementia. Secondly, when proxies have judged that their loved one has less than 6 months to live they are more likely to have discussed goals of care with the health care team, and less likely to agree to burdensome interventions.

The results of this study were published today in the Journal of the American Medical Association Internal Medicine (JAMA IM).

To discover these findings, researchers combined data from two studies which prospectively followed nursing home residents with advanced dementia and their proxies in the Boston area for 12 months. During quarterly telephone interviews, proxies stated whether they believed the resident they represented would live less than one month, 1-6 months, 7-12 months, or more than 12 months.

Researchers then examined the association between the proxies’ prognostic estimates and the receipt of burdensome treatments by the residents, such as hospital transfers, intravenoustherapy, tube-feeding, blood draws, and insertions of catheters into the bladder. They found that residents whose proxies believed they would die within 6 months, received fewer of these burdensome treatments compared to residents whose proxies thought they would live longer.

Lead author, Andrea Loizeau MSc, a visiting doctoral student at Marcus Institute from the Univeristy of Zurich, explains, “Proxies are reasonably good at estimating when nursing home residents with advanced dementia will die and their prognostic perceptions may influence the type of care the resident receives.”

This research was supported with the following grants: NIH-NIA R01 AG032982, NIH-NIA R01 AG043440, and NIH-NIA K2AG033640; the Swiss National Science Foundation P1AHP3_171747, and the Swiss Academy of Medical Sciences PC 22/14 The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About Marcus Institute

Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Musculoskeletal Center within Marcus Institute studies conditions affecting bone, muscle, and joint health with aging.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the non-profit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.