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Letters |

Health Values of Hospitalized Elderly Patients

Charles E. Gessert, MD
JAMA. 1998;279(20):1611-1612. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-20-jbk0527.
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To the Editor.—Dr Tsevat and colleagues'1 examination of the health values of hospitalized elderly patients makes a valuable contribution to the efforts to improve end-of-life care. However, as is often the case when values are in question, the data they present could be used to formulate somewhat different conclusions, and the article raises as many questions as it answers. The authors' finding that "most patients were unwilling to trade much time for excellent health" could have been reported as "59.2% were willing to accept some shortening of life in exchange for better health." Moreover, the conclusions should be weighed with due consideration of the effect of acute hospitalization, which may have diminished subjects' willingness to consider hypothetical alternatives to recovery. Also, the methods do not permit readers to determine what proportion of patients who declined to "trade" quantity of life for quality of life actually might have been entirely at peace with their mortality, in whatever form and at whatever pace it would overtake them. Such individuals would appear, in the data and in the conclusions, as people who supported life extension regardless of quality of life, when they could represent an entirely different point of view: acceptance of the natural debility and loss of control that occurs at the end of life.

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