A nationwide study on forgoing treatment in the Netherlands: do incidence and decision-making differ for different age groups?

Introduction: The ageing of the population raises the need to study end-of-life decision making for older people. Aims: To describe the in2cidence and decision-making on forgoing potentially life-prolonging treatment and whether it differs for different age groups. Methods: A nationwide study of a stratified sample from the death registry of Statistics Netherlands to which all deaths were reported in 2010. All attending physicians of those deaths received a questionnaire about end-of-life decisions (including withholding/withdrawing treatment and decision-making process). All cases were weighted to adjust for stratification and differences in response rates, reflecting all deaths in the Netherlands. We studied a total of 6600 cases and looked at three age groups: 80 years and over; 65-79 years; 17-64 years. Results: A higher incidence of forgoing treatment was found among the oldest patients (42% vs. 36% and 25%). The type of treatment most frequently withheld was artificial hydration/nutrition (41% vs. 36% and 21%). Medication was the most frequently withdrawn treatment among the oldest patients (65% vs. 49% and 41%). The most common reason to make the decision of forgoing treatment was “no chance of improvement” for all age groups (72%, 69% and 77%). The decision was not discussed with the patients in respectively 57%, 58% and 59% of the cases, mostly because the patient had dementia (41% of the oldest patients vs. 21% and 8%) or was unconscious (57% vs. 74% and 86%). Conclusions: Decisions to forgo treatment are made in a substantial proportion of older people in the Netherlands and more often than in younger age groups. Decisions could often not be discussed, which emphasises the relevance of advance care planning.