Factors influencing ICU referral at the end of life in the elderly

Abstract

Referral to the intensive care unit (ICU) and frequency of do-not-resuscitate (DNR) decisions at the end of life (EOL) in adult hospitalized patients≥75 years and those<75 years were examined and influencing factors in the elderly were determined. Data were prospectively collected in all adult patients who deceased during a 12-week period in 2007 and a 16-week period in 2008 at a university hospital in Belgium. Overall, 330 adult patients died of whom 33% were ≥75 years old. Patients≥75 years old were less often referred to ICU at the EOL (42% vs. 58%, p=0.008) and less frequently died in the ICU (31% vs. 46%, p=0.012) as compared to patients<75 years old. However, there was no difference in frequency of DNR decisions (87% vs. 88%, p=0.937) for patients dying on non-ICU wards. After adjusting for age, gender, and the Charlson comorbidity index, being admitted on a geriatric ward (OR 0.30, 95% CI 0.10-0.85, p=0.024) and having an active malignant disease (OR 0.39, 95% CI 0.19-0.78, p=0.008) were the only factors associated with a lower risk of dying in the ICU. Patients≥75 years are less often referred to the ICU at the EOL as compared to patients<75 years old. However, the risk of dying in the ICU was only lower for elderly with cancer and for those admitted to the geriatric ward.