title: Admission of the very elderly to the intensive care unit: family members' perspectives on clinical decision-making from a multicenter cohort study.
abstract: BACKGROUND
  Little is known about the perspectives and experiences of family members of very elderly patients who are admitted to the intensive care unit.
  
  
  OBJECTIVE
  To describe family members' perspectives about care provided to very elderly critically ill patients.
  
  
  METHODS
  Multicenter, prospective, cohort study.
  
  
  METHODS
  In total, 535 family members of patients aged 80 years or older admitted to 22 intensive care units for more than 24 h.
  
  
  RESULTS
  Family members reported that the "patient be comfortable and suffer as little as possible" was their most important value and "the belief that life should be preserved at all costs" was their least important value considered in making treatment decisions. Most family members (57.9%) preferred that life support be used for their family member, whereas 24.1% preferred comfort measures only, and 14.4% were unsure of their treatment preferences. Only 57.3% reported that a doctor had talked to them about treatment options for the patient. Overall, 29.7% of patients received life-sustaining treatments for more than 7 days and 50.3% of these died in hospital. Families were most satisfied with the skill and competency of nurses and least satisfied with being included and supported in the decision-making process and with their sense of control over the patient's care.
  
  
  CONCLUSIONS
  There is incongruity between family values and preferences for end-of-life care and actual care received for very elderly patients who are admitted to the intensive care unit. Deficiencies in communication and decision-making may be associated with prolonged use of life-sustaining treatments in very elderly critically ill patients, many of whom ultimately die.
authors: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada dkh2@queensu.ca.
authors: Daren K
authors: DK
authors: Heyland
authors: Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
authors: Peter
authors: P
authors: Dodek
authors: Mount Sinai Hospital, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
authors: Sangeeta
authors: S
authors: Mehta
authors: Department of Medicine and Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Deborah
authors: D
authors: Cook
authors: Department of Medicine and Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
authors: Allan
authors: A
authors: Garland
authors: Department of Critical Care Medicine, Institute for Public Health, University of Calgary and Alberta Health Services-Calgary Zone, Calgary, AB, Canada.
authors: Henry T
authors: HT
authors: Stelfox
authors: Division of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors: Sean M
authors: SM
authors: Bagshaw
authors: Division of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors: Demetrios J
authors: DJ
authors: Kutsogiannis
authors: Interdepartmental Division of Critical Care Medicine, University of Toronto and St. Michael's Hospital, Toronto, ON, Canada.
authors: Karen
authors: K
authors: Burns
authors: Critical Care Program, Queen's University, Kingston, ON, Canada.
authors: John
authors: J
authors: Muscedere
authors: Division of Critical Care Medicine and Population Health and Optimal Health Practices Research Unit, Centre Hospitalier Universitaire (CHU) de Québec and Université Laval, Québec, QC, Canada.
authors: Alexis F
authors: AF
authors: Turgeon
authors: Interdepartmental Division of Critical Care Medicine, University of Toronto and Sunnybrook Hospital, Toronto, ON, Canada.
authors: Rob
authors: R
authors: Fowler
authors: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.
authors: Xuran
authors: X
authors: Jiang
authors: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.
authors: Andrew G
authors: AG
authors: Day
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D003142:Communication; D003422:Critical Care; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011368:Professional-Family Relations; D011446:Prospective Studies; D011787:Quality of Health Care; D013727:Terminal Care; D055815:Young Adult
keywords: Palliative care; aged 80 years and over; critical illness; decision-making; frail elderly; longitudinal studies; outcome assessment (health care); terminal care