title: Are elderly patients' opinions sought before admission to an intensive care unit? Results of the ICE-CUB study.
abstract: BACKGROUND
  demand for intensive care of the very elderly is growing, but few studies report inclusion of their opinions in the admission decision-making process. Whether or not to refer a very elderly patient to intensive care unit is a difficult decision that should take into account individual wishes, out of respect for the patient's decision-making autonomy.
  
  
  METHODS
  in 15 emergency departments, patients over 80 years old who had a potential indication for admission to intensive care, and that were capable of expressing their opinion were included. Frequency of opinions sought before referral decision and individual and organisational factors associated were recorded and analysed.
  
  
  RESULTS
  a total of 2,115 patients were included. Only 270 (12.7%) of them were asked for their opinion, and there were marked variations between study centres (minimum: 1.1% and maximum: 53.6%). A history of dementia reduced the probability of a patient being asked for his or her opinion (OR 0.47, 95% CI: 0.25-0.83). Patients' opinion was most often sought when their functional autonomy was conserved (OR 2.10, 95% CI: 1.39-3.21) and when a relative had been questioned (OR 5.46, 95% CI: 3.8-7.88). Older attending physicians were less likely to ask for the patient's opinion (older physician versus younger physician, OR 0.48, 95% CI: 0.35-0.66).
  
  
  CONCLUSIONS
  elderly patients are therefore rarely asked for their opinion prior to intensive care admission. Our results indicate that respect of the decision-making autonomy of elderly subjects in the admission process to an intensive care unit should be reinforced.
authors.affiliation: Service de Gériatrie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Le Guen
authors.affiliation: Institut national de la santé et de la recherche médicale UMRS-707, Université Pierre et Marie Curie, Paris, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Boumendil
authors.affiliation: Service de Réanimation Médicale, Hôpital Saint Antoine, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: Centre de recherche sur l'action politique en Europe (CRAPE) UMR 6051, CNRS, Université Rennes 1, Rennes, France Service de Gériatrie, CHU de Rennes, Université Rennes 1, Faculté de médecine, Rennes, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Corvol
authors.affiliation: Service de Gériatrie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Saint-Jean
authors.affiliation: Service de Gériatrie, CHU de Rennes, Université Rennes 1, Faculté de médecine, Rennes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Somme
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002755:Choice Behavior; D003704:Dementia / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D015999:Multivariate Analysis; D016017:Odds Ratio; D010297:Paris; D010343:Patient Admission; D010358:Patient Participation; D010361:Patients / Q000523:psychology*; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D012307:Risk Factors
keywords: autonomy; decision-making process; intensive care; older people