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Institutional Variation in Life-Sustaining Treatments and Mortality Among Older Patients
Junji Shiotsuka1, Shigehiko Uchino2, Yusuke Sasabuchi3
1Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Tochigi, Japan.
JAMA Health Forum
|June 12, 2026
Summary
For older patients in intensive care units (ICUs), higher treatment intensity did not improve survival. This study highlights the need for better methods to identify elderly patients who benefit most from intensive care.
Area of Science:
- Gerontology
- Critical Care Medicine
- Health Services Research
Background:
- Optimal intensive care unit (ICU) treatment intensity for elderly patients (≥80 years) remains unclear.
- Significant institutional variation exists in critical care practices, but case-mix-adjusted variation in life-sustaining treatment use among older ICU patients is less understood.
- The association between institutional treatment intensity and survival in this demographic is not well-established.
Purpose of the Study:
- To quantify institutional variation in life-sustaining treatment use for patients aged 80 years and older admitted to ICUs.
- To investigate the relationship between treatment intensity and in-hospital mortality in this patient population.
Main Methods:
- Retrospective cohort study utilizing the Japanese Intensive Care Patient Database (JIPAD).
- Included 60,713 patients aged 80 years or older admitted to 127 ICUs in Japan (April 2015 - March 2023).
- Institutional treatment intensity measured by standardized treatment ratio (STR); association with mortality analyzed using multilevel logistic regression.
Main Results:
- Crude rates of life-sustaining treatment use varied widely across institutions (4.8% to 38.0%).
- Case-mix adjusted standardized treatment ratios (STR) also showed substantial variation (0.24 to 2.34).
- Higher institutional treatment intensity (high STR category) was not associated with improved in-hospital survival compared to intermediate intensity (OR, 1.17; 95% CrI, 0.91-1.39).
Conclusions:
- Substantial variation in life-sustaining treatment use exists among ICUs for older patients, even after adjusting for patient characteristics.
- Increased treatment intensity in ICUs does not appear to be associated with better in-hospital survival for patients aged 80 years and older.
- Further research is needed to develop better strategies for identifying older ICU patients who are most likely to benefit from intensive treatments.
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