Almost Half of Hospitalized Older Adults Require Help with Clinical Decision Making

Nearly half (47.4%) of older adults hospitalized for 48 hours required at least some involvement from a surrogate in clinical decision making, and almost a quarter (23.0%) required a surrogate to make all of their decisions, according to the results of a study published in the March 2014 JAMA Internal Medicine. The study included 1,083 patients age 65 or older who were admitted to the inpatient medicine and medical intensive care units (ICUs) in one of two university-affiliated hospitals with conditions requiring major medical decisions. The researchers found that among patients who required a surrogate for at least one decision within 48 hours, 57.2% required decisions about life-sustaining care, 48.6% required decisions about procedures and operations, and 46.9% required decisions about discharge planning. When compared with patients who made their own decisions, patients who needed a surrogate experienced a more complex hospital course with greater use of ventilators (2.5% versus 13.2%) and artificial nutrition (1.7% versus 14.4%) and longer lengths of stay (median of 6 days versus 7 days).