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The Very Elderly Admitted to ICU: A Quality Finish?
Daren Heyland1, Deborah Cook, Sean M Bagshaw
11Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. 2Department of Medicine, McMaster University, Hamilton, ON, Canada. 3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 4Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 5Department of Medicine, University of Manitoba, Winnipeg, MB, Canada. 6Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 7Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, AB, Canada. 8Alberta Health Services-Calgary Zone, Calgary, AB, Canada. 9Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. 10Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. 11Interdepartmental Division of Critical Care, St Michael's Hospital, University of Toronto, Toronto, ON, Canada. 12Department of Critical Care Medicine, Queens University, Kingston, ON, Canada. 13Department of Anesthesiology and Critical Care Medicine and Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec City, QC, Canada. 14Interdepartmental Division of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada.
Critically ill elderly patients (80+) often receive prolonged life-sustaining treatments in the ICU, with one-third dying in hospital. These intensive interventions did not significantly alter outcomes or shorten the time to death for this vulnerable population.
Area of Science:
- Geriatric Critical Care Medicine
- Intensive Care Unit (ICU) Outcomes
- End-of-Life Care Research
Background:
- Very elderly individuals (80+ years) admitted to intensive care units (ICUs) face a high risk of mortality.
- Understanding the utilization and impact of life-sustaining interventions in this demographic is crucial for clinical decision-making.
Purpose of the Study:
- To document the provision of life-sustaining interventions in very elderly ICU patients.
- To analyze the outcomes of critical care for patients aged 80 years and older.
- To investigate the association between interventions, length of stay, and mortality in this population.
Main Methods:
- A multicenter, prospective cohort study was conducted across 24 Canadian hospitals.
- Included were 1,671 patients aged 80 years or older admitted to the ICU.
- Data collected included demographics, length of stay, life-sustaining treatments (mechanical ventilation, vasopressors, renal replacement therapy), and mortality.
Main Results:
- The average age of the 1,671 included patients was 85 years.
- Thirty percent stayed in the ICU for 7 days or more, and 21% received life-sustaining treatments for at least 7 days.
- ICU and hospital mortality rates were 22% and 35%, respectively. Among nonsurvivors, 49% died while on mechanical ventilation, vasopressors, or dialysis. Frailty and advance directives had minimal impact on treatment use or time to death.
Conclusions:
- A significant proportion of very elderly ICU patients experience prolonged stays and aggressive life-sustaining interventions, with one-third dying in the hospital.
- These findings highlight critical questions regarding the appropriateness and utilization of intensive care resources for the very elderly at the end of life.
- Further research is needed to optimize end-of-life care strategies for this vulnerable patient group.
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