ABSTRACT
This chapter explores the first three factors as they relate to three types of life-sustaining care for the elderly: cardiopulmonary resuscitation (CPR), hemodialysis, and enteral feedings. It suggests that: CPR is both medically and economically inappropriate for certain groups of older people; hemodialysis is medically and economically appropriate for older people; and depending on the definition of effectiveness, enteral feedings are medically, but not economically, inappropriate for older patients with persistent vegetative state. Most older people, like the rest of the population, have exaggerated expectations of CPR. Clinical experience indicates that once older people understand CPR, the overwhelming majority prefer to forego CPR. In summary, CPR for chronically ill older people is both medically and economically inappropriate. The cost for chronic ambulatory peritoneal dialysis is approximately 65 percent of the cost of hospital dialysis. The cost-per-life-year can be estimated as the cost of long-term care plus the additional cost of the nutritional supplement.
