Characteristics and Outcomes of Elderly Patients Refused to ICUReport as inadecuate




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The Scientific World JournalVolume 2013 2013, Article ID 590837, 7 pages

Research Article

Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco, s-n, Alcalá de Henares, 28805 Madrid, Spain

Palliative Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain

Department of Medicine, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain

Received 15 August 2013; Accepted 1 October 2013

Academic Editors: C. Czech, G. Onder, and W. Schupp

Copyright © 2013 María-Consuelo Pintado et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. There are few data regarding the process of deciding which elderly patients are refused to ICU admission, their characteristics, and outcome. Methods. Prospective longitudinal observational cohort study. We included all consecutive patients older than 75 years, who were evaluated for admission to but were refused to treatment in ICU, during 18 months, with 12-month followup. We collected demographic data, ICU admission-refusal reasons, previous functional and cognitive status, comorbidity, severity of illness, and hospital and 12-month mortality. Results. 338 elderly patients were evaluated for ICU admission and 88 were refused to ICU 26%. Patients refused because they were “too ill to benefit” had more comorbidity and worse functional and mental situation than those admitted to ICU; there were no differences in illness severity. Hospital mortality rate of the whole study cohort was 36.3%, higher in patients “too ill to benefit” 55.6% versus 35.8%, , which also have higher 1-year mortality 73.7% versus 42.5%, . High comorbidity, low functional status, unavailable ICU beds, and age were associated with refusal decision on multivariate analysis. Conclusions. Prior functional status and comorbidity, not only the age or severity of illness, can help us more to make the right decision of admitting or refusing to ICU patients older than 75 years.





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Source: https://www.hindawi.com/



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