Nancy Schoenborn, a geriatrician at Johns Hopkins University’s School of Medicine, noticed that doctors increasingly are being told by their professional organizations to treat patients in the last decade or so of life differently. Less aggressive control of blood sugar and blood pressure makes sense for people with fewer years to go, the guidelines suggest. Screening tests for certain cancers probably won’t be beneficial if a patient is unlikely to live at least an additional 10 years.
The emphasis on life span rather than age stems from the recognition that health varies widely in the last chapters of life, and age alone is a poor predictor of how a patient is doing. A sick 65-year-old and a healthy 80-year-old might each have nine years left.
These new rules, though, present doctors like Schoenborn with a problem. How exactly is she supposed to explain her treatment decisions to patients?
This question led her to start asking older Americans how they want to talk about mortality with their doctors. Her recent survey, published in Annals of Family Medicine, revealed some surprising results.