The goal of this 5-year qualitative anthropological study is to describe and examine the specific ways in which 3 types of life-extending medical interventions for the elderly are affecting growing numbers of aging Americans, the physicians who treat them, their families, and the delivery of medical care in an aging society. The three types of intervention, never before studied for their effects on clinical and family obligation and end of life planning and care are: the automatic implantable cardiac defibrillator;living donor kidney transplant and living or cadaver donor liver transplant;and prostate and gynecological cancer treatments. These specific interventions have been selected for study for the following 2 reasons. They are affecting increasing numbers of elderly persons and are emblematic of the rising age for medical interventions of all kinds;and they exemplify both the successes of life-extension for those who are already elderly and the burdens and dilemmas of medical choice about aggressive treatments and chronic care for health practitioners, older persons, and their families. The long-term goal is to learn, in as much detail as possible, how life extension practices and the socio-medical developments surrounding them are impacting geriatric medicine, the health care older Americans receive, and the experience of elderly persons.
The specific aims of this empirical, ethnographic study are: 1) to discover and describe the criteria and rationale by which older patients, their families, and physicians decide to move forward, or not, with the 3 types of interventions;2) to learn how patients and families understand and live with treatments;3) to learn the effects of treatments on end of life planning;4) to explore what constitutes ethical and practical dilemmas and challenges surrounding life extension;5) to investigate clinical and family responsibilities regarding these treatments;and 6) to investigate ways in which recently expanded Medicare eligibility criteria affect physician, patient and family understandings of standard care and 'normal'old age. The traditional anthropological methods of participant-observation (in medical clinics) and in-depth interviews with small samples will be used to collect data from physicians, patients, and their family members. Well-known coding based qualitative data analysis techniques will be used to fully examine the study aims: cross-sectional comparison, case studies, thematic analysis, and frequencies of response. Relevance: This project will document the ways in which the proliferation of life-extending interventions for the elderly influences patients age 70 and over, families, the field of geriatric medicine and medical practice with older individuals generally. This study will provide data about physician decision-making and patient responses to both aggressive and palliative treatments that will be important for health consumers, health professionals in a variety of fields, academic geriatrics, and health care planning for an aging society.
