title: The ETHICA study (part I): elderly's thoughts about intensive care unit admission for life-sustaining treatments.
abstract: OBJECTIVE
  To assess preferences among individuals aged ≥80 years for a future hypothetical critical illness requiring life-sustaining treatments.
  
  
  METHODS
  Observational cohort study of consecutive community-dwelling elderly individuals previously hospitalised in medical or surgical wards and of volunteers residing in nursing homes or assisted-living facilities. The participants were interviewed at their place of residence after viewing films of scenarios involving the use of non-invasive mechanical ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of invasive mechanical ventilation (RRT after IMV). Demographic, clinical, and quality-of-life data were collected. Participants chose among four responses regarding life-sustaining treatments: consent, refusal, no opinion, and letting the physicians decide.
  
  
  RESULTS
  The sample size was 115 and the response rate 87 %. Mean participant age was 84.8 ± 3.5 years, 68 % were female, and 81 % and 71 % were independent for instrumental activities and activities of daily living, respectively. Refusal rates among the elderly were 27 % for NIV, 43 % for IMV, and 63 % for RRT (after IMV). Demographic characteristics associated with refusal were married status for NIV [relative risk (RR), 2.9; 95 % confidence interval (95 %CI), 1.5-5.8; p = 0.002] and female gender for IMV (RR, 2.4; 95 %CI, 1.2-4.5; p = 0.01) and RRT (after IMV) (RR, 2.7; 95 %CI, 1.4-5.2; p = 0.004). Quality of life was associated with choices regarding all three life-sustaining treatments.
  
  
  CONCLUSIONS
  Independent elderly individuals were rather reluctant to accept life-sustaining treatments, especially IMV and RRT (after IMV). Their quality of life was among the determinants of their choices.
authors.affiliation: Medical-Surgical, Saint Joseph Hospital Network, 75014, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Philippart
authors.forename: A
authors.initials: A
authors.lastname: Vesin
authors.forename: C
authors.initials: C
authors.lastname: Bruel
authors.forename: A
authors.initials: A
authors.lastname: Kpodji
authors.forename: B
authors.initials: B
authors.lastname: Durand-Gasselin
authors.forename: P
authors.initials: P
authors.lastname: Garçon
authors.forename: M
authors.initials: M
authors.lastname: Levy-Soussan
authors.forename: J L
authors.initials: JL
authors.lastname: Jagot
authors.forename: N
authors.initials: N
authors.lastname: Calvo-Verjat
authors.forename: J F
authors.initials: JF
authors.lastname: Timsit
authors.forename: B
authors.initials: B
authors.lastname: Misset
authors.forename: M
authors.initials: M
authors.lastname: Garrouste-Orgeas
mesh_terms: D000369:Aged, 80 and over; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D010343:Patient Admission; D057240:Patient Preference