One found that putting nursing-home residents with failing kidneys on dialysis did not improve their quality of life and may even push them into further decline. The other showed that many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.
Medical experts say the new research emphasizes the need for doctors, caregivers, and families to consider making feeble elderly people who are near death comfortable rather than treating them as if a cure were possible.
"We probably need to be offering a palliative-care option to many more patients to make the last days of their lives as comfortable as possible," said Dr. Mark Zeidel of the Beth Israel Deaconess Medical Center in Boston, which was not involved in the studies.
Palliative care focuses on managing symptoms of a disease. A main goal is to relieve pain at the end of life.
End-of-life care became a divisive issue in the national health-care reform debate this summer after one proposal included Medicare reimbursement for doctors who consult with patients on end-of-life counseling. Critics called the counseling "death panels" and a step toward euthanasia. The Obama administration denied those claims yet has signaled the Medicare benefit will be dropped.
The new studies are published in today's New England Journal of Medicine.
In one study, doctors looked at health records of 3,702 nursing-home residents nationwide who started dialysis between 1998 and 2000. The average age was 73, and many had other health problems, including diabetes, heart disease, and cancer.
Within the first year, 58 percent died and 29 percent declined in their ability to do simple tasks such as walking, bathing, and getting dressed.
The second study followed 323 people with advanced dementia from Boston-area nursing homes. Their average age was 85 and they could not recognize loved ones and were unable to talk or walk.
One out of four died within six months and half died during the 18 months they were followed.
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