Factors influencing ICU referral at the end of life in the elderly.
OBJECTIVE
Referral to the intensive care unit (ICU) and frequency of do-not-resuscitate (DNR) decisions at the end of life (EOL) in adult hospitalized patients≥75 years and those<75 years were examined and influencing factors in the elderly were determined.


METHODS
Data were prospectively collected in all adult patients who deceased during a 12-week period in 2007 and a 16-week period in 2008 at a university hospital in Belgium.


RESULTS
Overall, 330 adult patients died of whom 33% were ≥75 years old. Patients≥75 years old were less often referred to ICU at the EOL (42% vs. 58%, p=0.008) and less frequently died in the ICU (31% vs. 46%, p=0.012) as compared to patients<75 years old. However, there was no difference in frequency of DNR decisions (87% vs. 88%, p=0.937) for patients dying on non-ICU wards. After adjusting for age, gender, and the Charlson comorbidity index, being admitted on a geriatric ward (OR 0.30, 95% CI 0.10-0.85, p=0.024) and having an active malignant disease (OR 0.39, 95% CI 0.19-0.78, p=0.008) were the only factors associated with a lower risk of dying in the ICU.


CONCLUSIONS
Patients≥75 years are less often referred to the ICU at the EOL as compared to patients<75 years old. However, the risk of dying in the ICU was only lower for elderly with cancer and for those admitted to the geriatric ward.
Department of Geriatrics, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium. ruth.piers@ugent.be
R D
RD
Piers
D D
DD
Benoit
W J
WJ
Schrauwen
N J
NJ
Van Den Noortgate
D024362:Advance Directive Adherence / Q000706:statistics & numerical data; D000368:Aged; D001530:Belgium; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012307:Risk Factors; D016019:Survival Analysis; D013727:Terminal Care / Q000706:statistics & numerical data