title: High burden of palliative needs among older intensive care unit survivors transferred to post-acute care facilities. a single-center study.
abstract: BACKGROUND
  Adults with chronic critical illness (tracheostomy after ≥ 10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-acute care facilities.
  
  
  OBJECTIVE
  To determine whether older ICU survivors discharged to post-acute care facilities have potentially unmet palliative care needs.
  
  
  METHODS
  We examined electronic records from a 1-year cohort of 228 consecutive adults ≥ 65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality.
  
  
  RESULTS
  The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%.
  
  
  CONCLUSIONS
  Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.
authors.affiliation: 1 Department of Medicine, College of Physicians and Surgeons.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Baldwin
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: Paul A
authors.initials: PA
authors.lastname: Reyfman
authors.forename: Wazim R
authors.initials: WR
authors.lastname: Narain
authors.forename: Craig D
authors.initials: CD
authors.lastname: Blinderman
authors.forename: Neil W
authors.initials: NW
authors.lastname: Schluger
authors.forename: M Cary
authors.initials: MC
authors.lastname: Reid
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.forename: Nathan
authors.initials: N
authors.lastname: Goldstein
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.forename: Peter
authors.initials: P
authors.lastname: Bach
mesh_terms: D000359:Aftercare / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007362:Intensive Care Units; D008134:Long-Term Care; D008297:Male; D020380:Needs Assessment; D010166:Palliative Care / Q000706:statistics & numerical data*; D010360:Patient Transfer; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D017741:Survivors / Q000706:statistics & numerical data*