Role of age and cognitive abilities on knowledge of life-sustaining treatments and treatment preferences

ABSTRACT

Background: There has been an increased initiative for older adults to be active participants in the end-of-life decision-making process. Cognitive changes that occur as part of the normal aging process, including declines in processing speed and working memory, can negatively affect older adults’ comprehension of medical information. The present study investigated the relationship between age-related cognitive decline and the ability to learn about life-sustaining treatments (LSTs). It also explored the relationship between age-related cognitive decline and LST decisions.

Method: Participants were 92 undergraduate students and 58 community-dwelling older adults who received either information about LSTs or general health information. Their knowledge of LSTs, preference for LSTs, working memory, and processing speed were also assessed.

Results: Older adults demonstrated significantly worse cognitive abilities than young adults. Participants who read information specific to LSTs were significantly more knowledgeable about LSTs than participants who read information on general health, even after adjusting for cognitive abilities, indicating that they comprehended the information. Older adults in the general health information group were more knowledgeable about LSTs than young adults in the same information group. Older adults were significantly less likely to choose LSTs, even after adjusting for knowledge of LSTs. Reading information about LSTs did not produce any differences in preferences for LSTs between information groups.

Conclusions: Older adults can learn as well as young adults about LSTs, despite age-related changes in cognitive processing. Participants increased their knowledge of LSTs regardless of age. However, older adults’ decisions differed from young adults’, not because of knowledge, but because of preferences.

KEYWORDS:

• Life-sustaining treatments
• end-of-life
• advance care planning
• clinical decision-making

Ethical approval

The conduct of this research was approved by the Xavier University Institutional Review Board (Protocol #1270). This study was conducted as part of the first author's doctoral dissertation at Xavier University (Jost, 2014).

Disclosure statement

No potential conflict of interest was reported by the authors.

Acknowledgments

The authors thank Jess Petri, Aileen Maki, and Megan McPhillips for their help and support of data collection for this project, thank Bianca Velez-Cruz for assistance with data processing, and thank Wendy Rogers for assistance with conceptual aspects.

Notes on contributors

Lauren A. C. Jost is a clinical psychologist at the U.S. Department of Veterans Affairs, VA Pittsburgh Healthcare System, who specializes in working with older Veterans.

Cynthia L. Dulaney is a Professor of Psychology at Xavier University.

ORCID

Lauren A. C. Jost http://orcid.org/0000-0003-2099-3671

Cynthia L. Dulaney http://orcid.org/0000-0002-9855-5404

Additional information

Funding

A portion of the project was supported by an award to the first author from the Association for Professionals in Aging.