John R. O'Leary

Health Outcomes Associated with Polypharmacy in Community‐Dwelling Older Adults: A Systematic Review

To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community‐dwelling persons.

Unmet desire for caregiver-patient communication and increased caregiver burden.

Objectives: To examine the adequacy of caregiver‐patient communication in serious illness and its relationship to caregiver burden.

Inconsistency Over Time in the Preferences of Older Persons with Advanced Illness for Life-Sustaining Treatment

OBJECTIVES: To determine whether preferences for future attempts at life‐sustaining treatment change over time in a consistent and predictable manner.

Burden in caregivers of older adults with advanced illness.

OBJECTIVES: To examine caregiver burden over time in caregivers of patients with advanced chronic disease.

Are patient preferences for life-sustaining treatment really a barrier to hospice enrollment for older adults with serious illness?

OBJECTIVES: To determine whether patient preferences are a barrier to hospice enrollment.

Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study.

To identify novel modifiable risk factors, focusing on oral hygiene, for pneumonia requiring hospitalization of community‐dwelling older adults.

Religion, risk, and medical decision making at the end of life.

Objectives: The purpose of this study is to present empirical evidence about whether religious patients are more or less willing to undergo the risks associated with potentially life-sustaining treatment. Methods: At least every 4 months 226 older community-dwelling persons with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease were asked questions about several dimensions of religiousness and about their willingness to accept potentially life-sustaining treatment. Results: Results were mixed but persons who said that during their illness they grew closer to God (odds ratio [OR] = 1.79; 95% confidence intervals [CI] = 1.15, 2.78) or those grew spiritually (OR = 1.61; 95% CI = 1.03, 2.52) were more willing to accept risk associated with potentially life-sustaining treatment than were persons who did not report such growth. Discussion: Not all dimensions of religiousness have the same association with willingness to undergo potentially life-sustaining treatment. Seriously ill older, religious patients are not especially predisposed to avoid risk and resist treatment.

A Pilot Randomized Controlled Trial of a Decision Support Tool to Improve the Quality of Communication and Decision-Making in Individuals with Atrial Fibrillation

To design a tool for nonvalvular atrial fibrillation (NVAF) to inform individuals of their individual stroke and bleeding risks, assist in clarifying priorities, and promote communication.

Trajectories of Quality of Life in Older Persons with Advanced Illness

OBJECTIVES: To examine subjective ratings of quality of life (QoL) in older adults with advanced illness.

Older Adults’ Recognition of Trade-Offs in Healthcare Decision-Making

To examine older persons’ understanding of healthcare decision‐making involving trade‐offs.