Erschienen in:
16.06.2017 | Schädel-Hirn-Trauma | Original Article - Brain Injury
"I am not afraid of death"—a survey on preferences concerning neurosurgical interventions among patients over 75 years
verfasst von:
Claudia Unterhofer, Wing Mann Ho, Katrin Wittlinger, Claudius Thomé, Martin Ortler
Erschienen in:
Acta Neurochirurgica
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Ausgabe 8/2017
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Abstract
Introduction
Treatment decisions in elderly patients with traumatic brain injury (TBI) are mainly determined by trauma severity and patient age. The aim of this study was to explore personal preferences of potential patients regarding life-prolonging neurosurgical interventions by interviewing ambulatory, autonomous elderly people.
Methods
One hundred consecutive patients older than 75 years frequenting the outpatient clinic of the Department of Neurosurgery were interviewed about their attitudes regarding the hypothetical case of an 81-year-old patient with TBI and a space-occupying acute subdural hematoma (aSDH) using a 21-point questionnaire.
Results
Fifty-one percent of the consulted persons declined life-prolonging surgical measures. If surgery was associated with physical disability, 68% of the people wished no surgery. In case of cognitive impairment after surgery, 91% were against any surgical intervention. The majority feared being a burden to relatives (76%) and becoming unable to master an independent life (75%). Four-fifths of the interviewed patients (82%) were not afraid of death.
Conclusions
The majority of elderly patients only consent to surgical measures if no relevant disabilities are involved and if they can return to their previous life. These findings need consideration in case of life-threatening neurosurgical emergencies as well as in the surgical treatment of elderly patients in general.