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Factors influencing self-decision in withholding or withdrawal of life-sustaining treatments among older patients admitted to general hospital: A retrospective case-control study

Year: 2025

Type: article

Abstract: Purpose: This study aimed to identify factors influencing older patients' self-decision in withholding or withdrawing life-sustaining treatment (LST) during hospitalization. Methods: For this retrospective case-control study (self-decision versus family-decision groups), we used electronic medical records. The sample included 624 older patients who died after completing the LST implementation form. 249 (39.9%) patients were in the self-decision group versus 375 (60.1%) patients in the family-decision group. We performed chi-square tests, t-tests, and binary logistic regression. Results: Receiving treatment in an internal medicine department (odds ratio [OR]=12.60, 95% confidence interval [CI]=2.83~56.13), admission to a general ward (OR=2.83, 95% CI=1.33~6.02), experiencing pain (OR=2.64, 95% CI=1.68~4.13), being alert upon admission (OR=2.27, 95% CI=1.15~4.51), having a diagnosis of cancer (OR=2.01, 95% CI=1.16~3.49), and younger age (65~74 years) were significantly associated with an increased likelihood of self-decision. All factors increased the likelihood of self-decision. The self-decision group showed higher rates of withholding or withdrawing LST interventions (e.g., ventilators, dialysis, chemotherapy, extracorporeal membrane oxygenation, transfusions, and vasopressors) and received more hospice and palliative care with reduced Intensive Care Unit deaths. Conclusion: The self-decision group (i.e., those in internal medicine, with cancer, admitted to general wards, and maintaining consciousness) chose reduced futile LSTs. These findings highlight the need to develop a standardized protocol for counseling and education to facilitate informed end-of-life decisions among older inpatients.

Source: Journal of Korean Gerontological Nursing

DOI: 10.17079/jkgn.2025.00115

Authors: Young Min Jeong, Hee-Ju Kim

Institution: Catholic University of Korea

Language: English

Topic: Palliative Care and End-of-Life Issues

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4413804707