Concordance between elderly individuals and their designated surrogates with regard to life-sustaining treatment decisions

Paulette Joy Sansone, Fordham University


This study examined concordance between 153 Catholic and Jewish residents of two nursing homes and two senior citizen housing complexes and their designated surrogates regarding life-sustaining treatment decisions. Six hypothetical health care scenarios were used to measure concordance which was evaluated by assessing percent agreement and directionality of discordant responses. The three hypotheses tested examined the variables of age, living situation and mental status and their relationship to degree of concordance. In addition, analyses were done to determine if other variables such as education, religion, ethnicity, nature and closeness of the relationship, discussion of life-sustaining treatment, and execution of an advance directive were significantly associated with concordance. The findings revealed that a significant number of designated surrogates were not aware of their elderly loved one's wishes regarding life-sustaining treatment. The McNemar test for dependent pairs revealed a pattern of differences which were statistically significant at the.05 level. The proportion of pairs in which the older individual would want the surrogate to make a decision opposite from the one the surrogate said he/she would make ranged from 33% for chemotherapy to 52% for renal dialysis. When the treatment interventions the elderly would not want but the surrogate would provide were analyzed more specifically, the discordant responses ranged from 61% for chemotherapy to 92% for a feeding tube. The majority of the elderly did not want life-sustaining treatment regardless of the mental/physical condition presented. The surrogates, on the other hand, were more in favor of life-sustaining treatment when the older person was portrayed as fairly alert and functional. None of the variables analyzed proved to be significantly associated with concordance in even a majority of the scenarios. However, religion and ethnicity were each statistically significant in two of the six scenarios, and also proved statistically significant when analyzed with discussion of life-sustaining treatment and execution of an advance directive. This study's findings stress the need for better education and enhanced communication between elderly and surrogate around the issues of life-sustaining treatment. The findings also point out the inadequacies of an advance directive when knowledge, understanding and specificity are lacking.

Subject Area

Social work|Families & family life|Personal relationships|Sociology|Gerontology

Recommended Citation

Sansone, Paulette Joy, "Concordance between elderly individuals and their designated surrogates with regard to life-sustaining treatment decisions" (1992). ETD Collection for Fordham University. AAI9403302.