Are critically ill older patients treated differently than similarly ill younger patients?

Our goal was to determine whether critically ill older patients are treated differently than middle-aged patients. If so, what factors besides age contribute to that difference? Internal medicine residents (n = 46) and practicing internists (n = 41) received 8 clinical vignettes of 4 critically ill 85-year-old patients and 4 critically ill 50-year-old patients. Each patient had a distinct premorbid mental and physical state. Each respondent selected from 4 levels of therapeutic aggressiveness for each patient. The main outcome measure was the proportion of physicians who intended to treat the older of each matched pair of patients less aggressively than the younger one (that is, downgraded for age). Eight physicians (9%) treated a previously unimpaired 85-year-old patient less aggressively than a comparable 50-year-old patient. When the matched patients were either premorbidly mentally or physically impaired (but not both), about 20% of physicians downgraded for age. Most downgraded for age in matched patients who were premorbidly both mentally and physically impaired. We conclude that age alone does not engender much therapeutic bias against older patients as long as they are physically and mentally intact before the onset of their acute illness. As premorbid disabilities multiply, older patients may be treated less aggressively than younger ones with similar impairments and clinical presentations.