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Erschienen in:
01.12.2010 | Beiträge zum Themenschwerpunkt
Factors influencing ICU referral at the end of life in the elderly
Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 6/2010
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Objective
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.
Methods
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.
Results
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.
Conclusion
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.
