title: A retrospective cohort study of age-based differences in the care of hospitalized patients with sudden clinical deterioration.
abstract: OBJECTIVE
  The proportion of elderly patients is increasing, but it is unknown if there are age-based differences in care of hospitalized patients with sudden clinical deterioration. We sought to examine the relation between patient age and care for hospitalized patients experiencing sudden clinical deterioration.
  
  
  METHODS
  We identified hospitalized adults (n = 5103) in 4 hospitals with sudden clinical deteriorations triggering medical emergency team (MET) activation between January 1, 2007, and December 31, 2009. We compared intensive care unit (ICU) admission rates (within 2 hours of MET activation), goals of care (resuscitative vs nonresuscitative), and hospital mortality according to age (<50, 50-64, 65-79, and 80+ years), adjusting for patient, physician, and hospital characteristics.
  
  
  RESULTS
  Age was associated with decreased likelihood of admission to ICU (P < .0001) and increased likelihood of change in goals of care (P < .0001). Compared to patients younger than 50 years, patients 80 years or older had 67% lower odds of ICU admission (odds ratio, 0.33; 95% confidence interval, 0.26-0.41) and 587% higher odds (odds ratio, 6.87; 95% confidence interval, 4.20-11.26) of having their goals of care changed to exclude resuscitation. Hospital mortality was associated with patient age, ranging from 15% to 46% (P < .0001).
  
  
  CONCLUSIONS
  Patient age is associated with care for hospitalized patients with sudden clinical deterioration, suggesting that strategies to guide care of elderly patients during MET activation may be beneficial.
authors.affiliation: Departments of Critical Care Medicine, Medicine, and Community Health Sciences, Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Canada. Electronic address: tstelfox@ucalgary.ca.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada. Electronic address: sean.bagshaw@albertahealthservices.ca.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Alberta Health Services, Calgary, Canada. Electronic address: sgaoaaa@gmail.com.
authors.forename: Song
authors.initials: S
authors.lastname: Gao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D016330:Frail Elderly; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors
keywords: Age; Critical care; Hospital rapid response team; Mortality; Patient care planning