Understanding variability of end-of-life care in the ICU for the elderly

Excerpt

In the coming decade, US and European healthcare systems will be faced with a growing population of elderly patients with multiple chronic illnesses that raises questions about the most appropriate use of the ICU. Decisions about the use of life-sustaining treatments ought to be guided by a plan of care developed with patients who are knowledgeable and informed about their prognosis, treatment options, and likely outcomes. Unfortunately, current research raises questions about whether treatment decisions are based on patients’ informed goals of care. For example, a recent study from France suggests that many elderly patients are admitted to the ICU without involving patients or family members in a discussion about patients’ goals [1]. In the USA, the striking increase and substantial variability in ICU use among elderly patients with chronic illness, even those with severe functional impairment prior to critical illness, raises concerns about how ICU treatment decisions are made. For example, among nursing home residents with severe functional impairment, ICU use ranges from 0.8 % in Montana to 22 % in the District of Columbia [2]. …