Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study

Joseph B. Straton, Nae Yuh Wang, Lucy A. Meoni, Daniel E. Ford, Michael J. Klag, David Casarett, Joseph J. Gallo

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


OBJECTIVES: To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment. DESIGN: Mailed survey of older physicians. SETTING: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. PARTICIPANTS: Physicians who completed the life-sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n = 645, 83% of respondents to the 1998 questionnaire; mean age 68). MEASUREMENTS: Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette. RESULTS: Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6-year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR) = 2.14, 95% confidence interval (CI) = 1.18-3.88) to prefer high-burden life-sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR = 5.33, 95% CI = 1.60-17.8) to prefer high-burden treatment than respondents without declining function or worsening depression. CONCLUSION: This study calls attention to the need for clinical reassessment of preferences for potentially life-sustaining treatment when health has declined to prevent underestimating the preferences of older patients.

Original languageEnglish (US)
Pages (from-to)577-582
Number of pages6
JournalJournal of the American Geriatrics Society
Issue number4
StatePublished - Apr 2004


  • Advance directives
  • Decision-making
  • Depression
  • Quality of life
  • Resuscitation

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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