Cognitive Bias and Planning Error: Nullification of Evidence-Based Medicine in the Nursing Home

The uncertainty over the appropriateness of EBM for the nursing home patient has led to a widespread bias toward undertreatment that has reached alarming proportions. It is true that most elderly patients do not wish to extend their life expectancy, but most do wish to avoid medical complications and unnecessary hospitalizations. Rejecting treatments that extend life expectancy often results in rejection of the very treatments that would improve the probability of achieving their wish to retain fair health. Practitioners do not reject meaningful treatments because of lack of knowledge or lack of concern. They do so because of an incomplete education regarding the biases and cognitive pitfalls that are encountered when planning care for the elderly.