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"I am not afraid of death"—a survey on preferences concerning neurosurgical interventions among patients over 75 years

  • Original Article - Brain Injury
  • Published:
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Abstract

Introduction

Treatment decisions in elderly patients with traumatic brain injury (TBI) are mainly determined by trauma severity and patient age. The aim of this study was to explore personal preferences of potential patients regarding life-prolonging neurosurgical interventions by interviewing ambulatory, autonomous elderly people.

Methods

One hundred consecutive patients older than 75 years frequenting the outpatient clinic of the Department of Neurosurgery were interviewed about their attitudes regarding the hypothetical case of an 81-year-old patient with TBI and a space-occupying acute subdural hematoma (aSDH) using a 21-point questionnaire.

Results

Fifty-one percent of the consulted persons declined life-prolonging surgical measures. If surgery was associated with physical disability, 68% of the people wished no surgery. In case of cognitive impairment after surgery, 91% were against any surgical intervention. The majority feared being a burden to relatives (76%) and becoming unable to master an independent life (75%). Four-fifths of the interviewed patients (82%) were not afraid of death.

Conclusions

The majority of elderly patients only consent to surgical measures if no relevant disabilities are involved and if they can return to their previous life. These findings need consideration in case of life-threatening neurosurgical emergencies as well as in the surgical treatment of elderly patients in general.

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Authors and Affiliations

  1. Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Claudia Unterhofer, Wing Mann Ho, Katrin Wittlinger, Claudius Thomé & Martin Ortler

Authors
  1. Claudia Unterhofer
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  2. Wing Mann Ho
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  3. Katrin Wittlinger
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  4. Claudius Thomé
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  5. Martin Ortler
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Corresponding author

Correspondence to Claudia Unterhofer.

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Funding

No funding was received for this research.

Ethical approval

All patients gave informed consent to participate in the study. The study protocol was approved by the Ethics Committee of the Medical University Innsbruck (protocol no. AN 2016–0017 358/4.7).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Unterhofer, C., Ho, W.M., Wittlinger, K. et al. "I am not afraid of death"—a survey on preferences concerning neurosurgical interventions among patients over 75 years. Acta Neurochir 159, 1547–1552 (2017). https://doi.org/10.1007/s00701-017-3240-y

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  • DOI: https://doi.org/10.1007/s00701-017-3240-y

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