This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Joseph G. Ouslander, MD; Alexander J. Tymchuk, PhD; Bita Rahbar

Arch Intern Med. 1989;149(6):1367-1372.

Abstract
• Seventy residents of the residential care section of a long-term care facility were asked to make health decisions after being presented four clinical vignettes. Two vignettes involved high-risk procedures (aortic valve replacement and carotid endarterectomy) and two were low risk (flu vaccination and psychotropic medication). Comparisons were made between decisions made by the elderly participants and predictions of those decisions by potential proxies, including the participant's closest relative and a nurse, a social worker, and a physician in the facility. There was a low rate of agreement between decisions made by the elderly participant and the decisions the potential proxies thought they would make. The highest agreement was found between the participants' actual decision and the decision predicted by their relatives. The lowest agreement occurred between what the physician thought the participant would choose for the two high-risk vignettes and what the participant actually chose. The quality of the elderly participant's decisions was also rated on a four-point scale by the potential proxy, as well as by a researcher. Highest ratings of the quality of the elderly person's decision-making ability were assigned by the relative. A significant negative correlation was obtained between the elderly person's age and the decision-making rating assigned by the physician, and significant positive correlations were obtained between mental status and decision-making ratings by the other raters. These data have important Implications for designing and implementing strategies to maximize the ability of elderly people in long-term care settings to participate in decisions about their health care.

(Arch Intern Med. 1989; 149:1367-1372)

Author Affiliations
From the Multicampus Division of Geriatric Medicine (Dr Ouslander) and the Department of Psychiatry (Dr Tymchuk and Ms Rahbar), UCLA School of Medicine, Los Angeles, Calif.

Footnotes
Accepted for publication March 1,1989.

Reprint requests to Jewish Homes for the Aging of Greater Los Angeles, 18855 Victory Blvd, Reseda, CA 91335 (Dr Ouslander).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Speaking of research advance directives: Planning for future research participation
Stocking et al.
Neurology 2006;66:1361-1366.
ABSTRACT | FULL TEXT  

The accuracy of surrogate decision makers: a systematic review.
Shalowitz et al.
Arch Intern Med 2006;166:493-497.
ABSTRACT | FULL TEXT  

The Prognosis For Changes In End-Of-Life Care After The Schiavo Case
Hampson and Emanuel
Health Aff (Millwood) 2005;24:972-975.
ABSTRACT | FULL TEXT  

Family Surrogate Decision Making at the End of Life: Seeing them Through with Care and Respect
Meeker
Qual Health Res 2004;14:204-225.
ABSTRACT  

Advance care planning among residents in long-term care
McAuley and Travis
AM J HOSP PALLIAT CARE 2003;20:353-359.
ABSTRACT  

Approaching the End of Life: Attitudes, Preferences, and Behaviors of African-American and White Patients and Their Family Caregivers
Phipps et al.
JCO 2003;21:549-554.
ABSTRACT | FULL TEXT  

Predicting Elderly Outpatients' Life-Sustaining Treatment Preferences over Time: The Majority Rules
Houts et al.
Med Decis Making 2002;22:39-52.
ABSTRACT  

Advance Directives as Acts of Communication: A Randomized Controlled Trial
Ditto et al.
Arch Intern Med 2001;161:421-430.
ABSTRACT | FULL TEXT  

Accuracy of Primary Care and Hospital-Based Physicians' Predictions of Elderly Outpatients' Treatment Preferences With and Without Advance Directives
Coppola et al.
Arch Intern Med 2001;161:431-440.
ABSTRACT | FULL TEXT  

Do Surrogate Decision Makers Provide Accurate Consent for Intensive Care Research?
Coppolino and Ackerson
Chest 2001;119:603-612.
ABSTRACT | FULL TEXT  

Plan ahead: How neurologists can enhance patient-centered medicine
Bernat
Neurology 2001;56:144-145.
FULL TEXT  

Modal Preferences Predict Elderly Patients' Life-sustaining Treatment Choices as Well as Patients' Chosen Surrogates Do
Smucker et al.
Med Decis Making 2000;20:271-280.
ABSTRACT  

Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders in the Nursing Home
Zweig
Arch Fam Med 1997;6:424-429.
ABSTRACT  

Is Experience a Good Teacher?: How Interns and Attending Physicians Understand Patients' Choices for End-of-life Care
Wilson et al.
Med Decis Making 1997;17:217-227.
ABSTRACT  

Marked Improvement in Recognition and Completion of Health Care Proxies: A Randomized Controlled Trial of Counseling by Hospital Patient Representatives
Meier et al.
Arch Intern Med 1996;156:1227-1232.
ABSTRACT  

Advance End-of-Life Treatment Planning
Miles et al.
Arch Intern Med 1996;156:1062-1068.
ABSTRACT  

Nursing Home Residents' Preferences for Life-Sustaining Treatments
O'Brien et al.
JAMA 1995;274:1775-1779.
ABSTRACT  

Advance Directives: A Policy-capturing Approach
Raymark et al.
Med Decis Making 1995;15:217-226.
ABSTRACT  

Changes in Decisions by Elderly Persons Based on Treatment Description
Ainslie and Beisecker
Arch Intern Med 1994;154:2225-2233.
ABSTRACT  

Advance Directives: Stability of Patients' Treatment Choices
Emanuel et al.
Arch Intern Med 1994;154:209-217.
ABSTRACT  

Myth of Substituted Judgment: Surrogate Decision Making Regarding Life Support Is Unreliable
Suhl et al.
Arch Intern Med 1994;154:90-96.
ABSTRACT  

Relationship of General Advance Directive Instructions to Specific Life-Sustaining Treatment Preferences in Patients With Serious Illness
Schneiderman et al.
Arch Intern Med 1992;152:2114-2122.
ABSTRACT  

Surrogate Decision-Maker Preferences for Medical Care of Severely Demented Nursing Home Patients
Cogen et al.
Arch Intern Med 1992;152:1885-1888.
ABSTRACT  

Should Physicians Aid Their Patients in Dying? The Public Perspective
Blendon et al.
JAMA 1992;267:2658-2662.
 

Agreement Between Patients and Their Self-selected Surrogates on Difficult Medical Decisions
Hare et al.
Arch Intern Med 1992;152:1049-1054.
ABSTRACT  

Proxy Decision Making for Incompetent Patients: An Ethical and Empirical Analysis
Emanuel and Emanuel
JAMA 1992;267:2067-2071.
ABSTRACT  

Advancing the Cause of Advance Directives
Singer and Siegler
Arch Intern Med 1992;152:22-24.
ABSTRACT  

Advance Directives on Admission Clinical Implications and Analysis of the Patient Self-Determination Act of 1990
La Puma et al.
JAMA 1991;266:402-405.
ABSTRACT  

Substituted Judgment: How Accurate Are Proxy Predictions?
Seckler et al.
ANN INTERN MED 1991;115:92-98.
ABSTRACT  

Life-Sustaining Therapy: A Model for Appropriate Use
Murphy and Matchar
JAMA 1990;264:2103-2108.
ABSTRACT  

Medical Care in the Nursing Home
Ouslander
JAMA 1989;262:2582-2590.
ABSTRACT