Do-Not-Resuscitate Orders in the Elderly: Age Discrimination or Patient Preference?-Reply

The reasons why elderly patients are more likely to have DNR orders written remain unclear. Our study^' demonstrated that older patients with the same severity of illness as younger patients were significantly more likely to have a DNR order in spite of not being any more severely ill and therefore not any less likely to benefit from a resuscitation effort. We conclude that our findings suggest that there is age discrimination but acknowledge that they do not prove age discrimination.

Rosenfeld and Wenger's explanation for our observation that "higher DNR rates represent provider responsiveness to elderly patients' own values and preferences"¹ also remains unproved. The necessary information—how these decisions are made—is not readily available. In fact, evidence exists that suggests that providers are not responsive to their patient's requests regarding end-of-life care.^2,3 The recent SUPPORT results⁴ demonstrated that physicians do not accurately respond to the wishes of