Hospitalization and Intensive Therapy at the End of Life

Area of Science:

• Healthcare research
• Public health
• Geriatric medicine

Background:

• Germany possesses a higher per capita number of intensive care unit (ICU) beds compared to the USA.
• The utilization patterns of these critical care resources for end-of-life care in Germany remain largely unexamined.

Purpose of the Study:

• To investigate the trends in intensive care unit (ICU) utilization among patients who died in hospitals in Germany between 2007 and 2015.
• To analyze the association between age and the use of ICU services during terminal hospitalizations.

Main Methods:

• A retrospective observational study design was employed.
• Nationwide German hospital discharge data (diagnosis-related groups statistics) from 2007 to 2015 were analyzed.
• Population-based incidences were standardized for age and sex.

Main Results:

• Hospital admissions increased by 0.8% annually, while those involving ICU care rose by 3.0% annually.
• The proportion of hospital deaths with ICU care increased by 2.3% annually, reaching 25.6% by 2015.
• ICU use during terminal hospitalizations grew three times faster than hospital deaths in patients aged 65 and older.

Conclusions:

• Intensive care unit (ICU) services are increasingly utilized for end-of-life care across all age groups, with a notable acceleration in the elderly population.
• The rising demand for ICU-based end-of-life care necessitates advancements in educational, policy, and reimbursement frameworks.
• The appropriateness and alignment of ICU care with patient preferences during terminal phases require further investigation.