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Treatment-limiting decisions, comorbidities, and mortality in the emergency departments: a cross-sectional elderly
L de Decker1, O Beauchet, A Gouraud-Tanguy
1Department of Geriatrics, Nantes University Hospital, Nantes, France. laure.dedecker@chu-nantes.fr
Insights
Older adults with a high Charlson Comorbidity Index (CCI) score (≥5) are more likely to have treatment-limiting decisions in emergency departments (EDs). This finding highlights the importance of comorbidity assessment in end-of-life care for elderly patients.
Area of Science:
- Geriatric Emergency Medicine
- Clinical Epidemiology
- Health Services Research
Background:
- Older adults face elevated mortality risks in emergency departments (EDs), often linked to comorbidities.
- Treatment-limiting decisions are frequently documented for elderly patients who die in EDs.
- The Charlson Comorbidity Index (CCI) is a validated comorbidity scoring system, but its association with treatment limitations in EDs is unclear.
Purpose of the Study:
- To investigate the association between the Charlson Comorbidity Index (CCI) and treatment-limiting decisions in older patients who died in the ED.
- To identify factors influencing end-of-life care decisions for elderly patients in emergency settings.
Main Methods:
- Prospective study of 2,095 patients aged 65+ who died in EDs in France and Belgium (2004-2005).
- Data collected included CCI score, age, gender, institutional living, prior hospitalizations, functional limitations, chronic diseases, and organ failure.
- Treatment-limiting decisions were defined as foregoing life-sustaining therapies.
Main Results:
- Nearly half (47%) of patients had a treatment-limiting decision.
- A CCI score of 5 or higher significantly increased the odds of a treatment-limiting decision (OR=25.56, P=0.037).
- Other significant factors included advanced age (≥85 years), institutional living, hematologic and respiratory diseases, and neurologic organ failure.
Conclusions:
- An elevated Charlson Comorbidity Index (CCI) score (≥5) is associated with treatment-limiting decisions in elderly patients in the ED.
- This association suggests that comorbidity burden influences end-of-life care choices for older adults.
- Further research is warranted to confirm these findings and explore their clinical implications.
Background:
Older adults experience a higher risk of death in the emergency departments (EDs), in part, as a result of their comorbidities. A treatment-limiting decision is often reported for older adults who die in the EDs. The Charlson Comorbidity Index (CCI) is a validated method for the scoring of comorbidities. Whether an association between the CCI and treatment-limiting decisions exists remains unknown.
Objective:
To determine whether the CCI was associated with the treatment-limiting decisions made for older patients who die in the EDs.
Methods:
A total of 2,095 patients ≥65 years old who died in the EDs in France and Belgium were prospectively included between 2004 and 2005. The recorded data included: 1) the CCI score; 2) patient age; 3) gender; 4) living in senior housing facilities; 5) hospitalizations occurring in the previous year; 6) presence of functional limitations (according to the Knaus classification); 7) chronic diseases; and 8) presence of organ failure(s). A treatment-limiting decision was defined as a predetermined choice not to implement therapies that would otherwise be required to sustain life.
Results:
A treatment-limiting decision was identified in 993 (47%) patients. Fully-adjusted logistic regression model showed that a CCI ≥ 5 (OR=25.56 with P=0.037), age ≥85years (OR=20.33 with P<0.001), living in an institution (OR=0.15 with P=0.017), hematologic (OR=6.92 with P=0.020) and respiratory disease (OR=0.17 with P=0.046), and neurologic causes (OR=0.20 with P=0.010) of organ failure were significantly associated with treatment-limiting decisions.
Conclusion:
An elevated CCI score (≥5) was associated with a treatment-limiting decision in elderly patients evaluated in the EDs. Further research is needed to corroborate this finding.
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