Association between physician age and patterns of end-of-life care among older Americans.

Gotanda H, Ikesu R, Walling AM, Zhang JJ, Xu H, Reuben DB, Wenger NS, Damberg CL, Zingmond DS, Jena AB, Gross N, Tsugawa Y. Association between physician age and patterns of end-of-life care among older Americans. Journal of the American Geriatrics Society. 2024 May 9.

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Abstract:

BACKGROUND: End-of-life (EOL) care patterns may differ by physician age given differences in how physicians are trained or changes associated with aging. We sought to compare patterns of EOL care delivered to older Americans according to physician age. METHODS: We conducted a cross-sectional study of a 20% sample of Medicare fee-for-service beneficiaries aged 66 years who died in 2016-2019 (n = 487,293). We attributed beneficiaries to the physician who had > 50% of primary care visits during the last 6 months of life. We compared beneficiary-level outcomes by physician age ( < 40, 40-49, 50-59, or 60) in two areas: (1) advance care planning (ACP) and palliative care; and (2) high-intensity care at the EOL. RESULTS: Beneficiaries attributed to younger physicians had slightly higher proportions of billed ACP (adjusted proportions, 17.1%, 16.1%, 15.5%, and 14.0% for physicians aged < 40, 40-49, 50-59, and 60, respectively; p-for-trend adjusted for multiple comparisons < 0.001) and palliative care counseling or hospice use in the last 180 days of life (64.5%, 63.6%, 61.9%, and 60.8%; p-for-trend < 0.001). Similarly, physicians' younger age was associated with slightly lower proportions of emergency department visits (57.4%, 57.0%, 57.4%, and 58.1%; p-for-trend < 0.001), hospital admissions (51.2%, 51.1%, 51.4%, and 52.1%; p-for-trend < 0.001), intensive care unit admissions (27.8%, 27.9%, 28.2%, and 28.3%; p-for-trend = 0.03), or mechanical ventilation or cardiopulmonary resuscitation (14.2, 14.9%, 15.2%, and 15.3%; p-for-trend < 0.001) in the last 30 days of life, and in-hospital death (20.2%, 20.6%, 21.3%, and 21.5%; p-for-trend < 0.001). CONCLUSIONS: We found that differences in patterns of EOL care between beneficiaries cared for by younger and older physicians were small, and thus, not clinically meaningful. Future research is warranted to understand the factors that can influence patterns of EOL care provided by physicians, including initial and continuing medical education.