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The ETHICA study (part I): elderly’s thoughts about intensive care unit admission for life-sustaining treatments

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Abstract

Purpose

To assess preferences among individuals aged ≥80 years for a future hypothetical critical illness requiring life-sustaining treatments.

Methods

Observational cohort study of consecutive community-dwelling elderly individuals previously hospitalised in medical or surgical wards and of volunteers residing in nursing homes or assisted-living facilities. The participants were interviewed at their place of residence after viewing films of scenarios involving the use of non-invasive mechanical ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of invasive mechanical ventilation (RRT after IMV). Demographic, clinical, and quality-of-life data were collected. Participants chose among four responses regarding life-sustaining treatments: consent, refusal, no opinion, and letting the physicians decide.

Results

The sample size was 115 and the response rate 87 %. Mean participant age was 84.8 ± 3.5 years, 68 % were female, and 81 % and 71 % were independent for instrumental activities and activities of daily living, respectively. Refusal rates among the elderly were 27 % for NIV, 43 % for IMV, and 63 % for RRT (after IMV). Demographic characteristics associated with refusal were married status for NIV [relative risk (RR), 2.9; 95 % confidence interval (95 %CI), 1.5–5.8; p = 0.002] and female gender for IMV (RR, 2.4; 95 %CI, 1.2–4.5; p = 0.01) and RRT (after IMV) (RR, 2.7; 95 %CI, 1.4–5.2; p = 0.004). Quality of life was associated with choices regarding all three life-sustaining treatments.

Conclusions

Independent elderly individuals were rather reluctant to accept life-sustaining treatments, especially IMV and RRT (after IMV). Their quality of life was among the determinants of their choices.

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Acknowledgments

We thank A. Wolfe, MD, for her assistance in preparing the manuscript. We are grateful to The French Society of Critical Care (SRLF) and Fondation de France for supporting this study. We thank Joelle Hedaya, Michel d’Urso, MD, Hélène Robbiani, MD, and Christine Richet for welcoming us in their nursing facilities to interview elderly individuals. This study was supported by the French Society for Critical Care (SRLF) and the Fondation de France. These organisations had no role in the design or conduct of the study; in data collection, management, or interpretation; or in the writing of the manuscript.

Author information

Authors and Affiliations

  1. Medical-Surgical, Saint Joseph Hospital Network, 75014, Paris, France

    F. Philippart, C. Bruel, A. Kpodji, B. Misset & M. Garrouste-Orgeas

  2. René Descartes University, 75005, Paris, France

    F. Philippart & B. Misset

  3. Department of Biostatistics, Outcomerea, La Tronche, France

    A. Vesin & J. F. Timsit

  4. Geriatric Unit, Saint Joseph Hospital Network, 75014, Paris, France

    B. Durand-Gasselin

  5. Cardiology Unit, Saint Joseph Hospital Network, 75014, Paris, France

    P. Garçon

  6. Palliative Care Unit, University Hospital La Pitié Salpétrière, 75014, Paris, France

    M. Levy-Soussan

  7. Pulmonology Unit, Saint Joseph Hospital Network, 75014, Paris, France

    J. L. Jagot

  8. Gastrointestinal Surgery Unit, Saint Joseph Hospital Network, 75014, Paris, France

    N. Calvo-Verjat

  9. Integrated Research Center U823 Epidemiology of Cancers and Severe Diseases, Albert Bonniot Institute, Joseph Fourier University, Rond-point de la Chantourne, 38706, La Tronche Cedex, France

    J. F. Timsit & M. Garrouste-Orgeas

  10. Medical ICU, University Hospital Albert Michallon, 38043, Grenoble, France

    J. F. Timsit

  11. Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France

    M. Garrouste-Orgeas

Authors
  1. F. Philippart
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  2. A. Vesin
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  9. N. Calvo-Verjat
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  10. J. F. Timsit
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  12. M. Garrouste-Orgeas
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Corresponding author

Correspondence to M. Garrouste-Orgeas.

Additional information

Part II of the ETHICA Study can be found at: doi:10.1007/s00134-013-2977-x; an editorial discussing both parts of the ETHICA Study can be found at: doi:10.1007/s00134-013-2968-y.

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Philippart, F., Vesin, A., Bruel, C. et al. The ETHICA study (part I): elderly’s thoughts about intensive care unit admission for life-sustaining treatments. Intensive Care Med 39, 1565–1573 (2013). https://doi.org/10.1007/s00134-013-2976-y

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  • DOI: https://doi.org/10.1007/s00134-013-2976-y

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