Physicians' impression on the elders' functionality influences decision making for emergency care.

Area of Science:

• Geriatric Medicine
• Emergency Medicine
• Clinical Decision-Making

Background:

• Limited research exists on emergency physicians' criteria for selecting elderly patients for intensive care.
• Understanding these criteria is crucial for equitable allocation of critical care resources.

Purpose of the Study:

• To analyze the factors influencing emergency physicians' decisions regarding intensive care for elderly patients.
• To investigate the accuracy of physicians' perceptions of patient functional and cognitive status.

Main Methods:

• Cross-sectional study at 4 university hospitals involving 101 elderly patients and their physicians.
• Physicians forecasted treatment plans, including cardiopulmonary resuscitation or critical care admission.
• Data collected on physician reasoning, patient functional (Katz index), and cognitive status (Informant Questionnaire on Cognitive Decline in the Elderly).

Main Results:

• Physicians' perceptions of patient functional and mental status significantly influenced decisions on intensive care.
• Multivariate analysis identified patient age, perceived functional, and mental status as key decision factors.
• Discrepancies noted between physician perceptions and validated measures of patient functional and cognitive status.

Conclusions:

• Physician impressions of elderly patient status heavily impact intensive care selection, even when inaccurate.
• This highlights a potential bias in critical care allocation for older adults.
• Further research is needed to refine objective criteria for intensive care decisions in geriatrics.