title: Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission.
abstract: OBJECTIVE
  To describe triage decisions and subsequent outcomes in octogenarians referred to an ICU.
  
  
  METHODS
  Prospective observational study in the medical ICU in a tertiary nonuniversity hospital.
  
  
  METHODS
  Cohort of 180 patients aged 80 years or over who were triaged for admission.
  
  
  METHODS
  Age, underlying diseases, admission diagnoses, Mortality Probability Model score, and mortality were recorded. Self-sufficiency (Katz Index of Activities of Daily Living) and quality of life (modified Perceived Quality of Life scale and Nottingham Health Profile) were measured 1year after triage.
  
  
  RESULTS
  In 132 patients (73.3%) ICU admission was refused, including 79 (43.8%) considered too sick to benefit. Factors independently associated with refusal were nonsurgical status, age older than 85 years, and full unit. Greater self-sufficiency was associated with ICU admission. Hospital mortality was 30/48 (62.5%), 56/79 (70.8%), 9/51 (17.6%), and 0/2 in the admitted, too sick to benefit, too well to benefit, and family/patient refusal groups, respectively; 1-year mortality was 34/48 (70.8%), 69/79 (87.3%), 24/51 (47%), and 0/2, respectively. Self-sufficiency was unchanged by ICU stay. Quality of life (known in only 28 patients) was significantly poorer for isolation, emotional, and mobility domains compared to the French general population matched on sex and age.
  
  
  CONCLUSIONS
  More than two-thirds of patients aged over 80 years referred to our ICU were denied admission. One year later self-sufficiency was not modified and quality of life was poorer than in the general population. These results indicate a need to discuss patient preferences before triage decisions.
authors.affiliation: Medical ICU, Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France. mgarrouste@hopital-saint-joseph.org
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Luc
authors.initials: L
authors.lastname: Montuclard
authors.forename: Alain
authors.initials: A
authors.lastname: Colvez
authors.forename: Olivier
authors.initials: O
authors.lastname: Gattolliat
authors.forename: François
authors.initials: F
authors.lastname: Philippart
authors.forename: Guillaume
authors.initials: G
authors.lastname: Rigal
authors.forename: Benoit
authors.initials: B
authors.lastname: Misset
authors.forename: Jean
authors.initials: J
authors.lastname: Carlet
mesh_terms: D000369:Aged, 80 and over; D000704:Analysis of Variance; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D003657:Decision Making; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation; D016079:Refusal to Treat; D018709:Statistics, Nonparametric; D014218:Triage