Intensive Care Medicine

, Volume 32, Issue 7, pp 1045–1051 | Cite as

Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission

  • Maité Garrouste-Orgeas
  • Jean-François Timsit
  • Luc Montuclard
  • Alain Colvez
  • Olivier Gattolliat
  • François Philippart
  • Guillaume Rigal
  • Benoit Misset
  • Jean Carlet
Original

Abstract

Objective

To describe triage decisions and subsequent outcomes in octogenarians referred to an ICU.

Design and setting

Prospective observational study in the medical ICU in a tertiary nonuniversity hospital.

Participants

Cohort of 180 patients aged 80 years or over who were triaged for admission.

Measurements

Age, underlying diseases, admission diagnoses, Mortality Probability Model score, and mortality were recorded. Self-sufficiency (Katz Index of Activities of Daily Living) and quality of life (modified Perceived Quality of Life scale and Nottingham Health Profile) were measured 1 year after triage.

Results

In 132 patients (73.3%) ICU admission was refused, including 79 (43.8%) considered too sick to benefit. Factors independently associated with refusal were nonsurgical status, age older than 85 years, and full unit. Greater self-sufficiency was associated with ICU admission. Hospital mortality was 30/48 (62.5%), 56/79 (70.8%), 9/51 (17.6%), and 0/2 in the admitted, too sick to benefit, too well to benefit, and family/patient refusal groups, respectively; 1-year mortality was 34/48 (70.8%), 69/79 (87.3%), 24/51 (47%), and 0/2, respectively. Self-sufficiency was unchanged by ICU stay. Quality of life (known in only 28 patients) was significantly poorer for isolation, emotional, and mobility domains compared to the French general population matched on sex and age.

Conclusions

More than two-thirds of patients aged over 80 years referred to our ICU were denied admission. One year later self-sufficiency was not modified and quality of life was poorer than in the general population. These results indicate a need to discuss patient preferences before triage decisions.

Keywords

Intensive care unit Triage Elderly Quality of life Ethics 

Notes

Acknowledgements

We thank A. Wolfe, MD, for helping to prepare this manuscript.

Supplementary material

134_2006_169_MOESM1_ESM.doc (98 kb)
Electronic Supplementary Material (DOC 100kb)

References

  1. 1.
    Somogyi-Zalud E, Zhong Z, Hamel MB, Lynn J (2002) The use of life-sustaining treatments in hospitalized persons aged 80 and older. J Am Geriatr Soc 50:930–934CrossRefPubMedGoogle Scholar
  2. 2.
    Tsevat J, Dawson NV, Wu AW, Lynn J, Soukup JR, Cook F, Vidaillet H, Phillips RS for the HELP investigators (1998) Health values of hospitalized patients 80 years or older. JAMA 279:371–375CrossRefPubMedGoogle Scholar
  3. 3.
    Nilsson M, Eckman S, Ericsson K, Winblad B (1996) Some characteristics of the quality of life in old age illustrated by mean's of Allardt's concept. Scand J Caring Sci 116–121Google Scholar
  4. 4.
    Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short and long term outcomes. Intensive Care Med 29:2137–2143CrossRefPubMedGoogle Scholar
  5. 5.
    Boumendil A, Maury E, Reinhard I, Luquet L, Offenstadt G, Guidet B (2004) Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 30:647–654CrossRefPubMedGoogle Scholar
  6. 6.
    Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste-Orgeas M, Cohen Y, Thuong M, Paugam C, Appere C, De Cagny B, Brun F, Borstein C, Parrot A, Tamion F, Lacherade JC, Bouffard Y, Le Gall JR, Herve C, Grassin M, Zittoun R, Schlemmer B, Dhainaut JF (2001) Compliance with triage to intensive care recommendations. Crit Care Med 29:2132–2139CrossRefPubMedGoogle Scholar
  7. 7.
    Sprung CL, Geber D, Eidelman LA, Baras M, Pizov R, Nimrod A (1999) Evaluation of triage decisions for intensive care admission. Crit Care Med 27:1073–1079CrossRefPubMedGoogle Scholar
  8. 8.
    Joynt GM, Gomersall CD, Tan P, Lee A, Ai YU Chen C, Lai Yi Wong E (2001) Prospective evaluation of patients refused admission to intensive care unit: triage, futility and outcome. Intensive Care Med 27:1459–1465CrossRefPubMedGoogle Scholar
  9. 9.
    Chelluri L, Pinski MR, Grenvik A (1992) Outcome of intensive care of the oldest-old critically ill patients. Crit Care Med 20:757–761PubMedCrossRefGoogle Scholar
  10. 10.
    Covinski KE, Wu AW, Landefeld S, Connors AF, Phillips RS, Tsevat J, Dawson NV, Lynn J, Fortinsky RH (1999) Health status versus quality of life in older patients: does the distinction matter? Am J Med 106:435–440CrossRefPubMedGoogle Scholar
  11. 11.
    Kass JE, Castriotta BJ, Malakoff F (1992) Intensive care unit outcome in the very elderly. Crit Care Med 20:1666–1671PubMedCrossRefGoogle Scholar
  12. 12.
    Garrouste-Orgeas M, Timsit JF, Montuclard L, Gattolliat O, Philippart F, Rigal G, Misset B, Carlet J (2004) Preliminary study of ICU admission procedures in patients over 80 years and one-year outcome, functional capacity and quality of life. Intensive Care Med 30:S101CrossRefGoogle Scholar
  13. 13.
    Garrouste-Orgeas M, Montuclard L, Timsit JF, Misset B, Christias M, Carlet J (2003) Triaging patients to the ICU: a pilot study of factors influencing admission decision and outcome. Intensive Care Med 29:774–781PubMedGoogle Scholar
  14. 14.
    Garrouste-Orgeas M, Montuclard L, Reignier J, Desmettre T, Karoubi P, Moreau D, Montesino L, Duguet A, Boussat S, Ede C, Monseau Y, Paule T, Misset B, Carlet J (2005) Predictors of ICU refusal in French ICUs. Crit Care Med 33:750–755CrossRefPubMedGoogle Scholar
  15. 15.
    McCabe WR, Jackson GG (1962) Gram negative bacteremia: etiology and ecology. Arch Intern Med 110:847–855Google Scholar
  16. 16.
    Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) APACHE acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9:591–597PubMedGoogle Scholar
  17. 17.
    Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J (1993) Mortality Probability Models (MPM II) based on an interpretation cohort of intensive care unit patients. JAMA 270:2478–2486CrossRefPubMedGoogle Scholar
  18. 18.
    Katz S (1983) Assessing self maintenance: activities of daily living, mobility and instrumental activities of daily living. J Am Geriatr Soc 31:721–727PubMedGoogle Scholar
  19. 19.
    Ridley SA, Wallace PGM (1990) Quality of life after intensive care. Anesthesia 45:808–813CrossRefGoogle Scholar
  20. 20.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American Multicenter study. JAMA 270:2957–2963CrossRefPubMedGoogle Scholar
  21. 21.
    Thompson BT, Cox PN, Antonelli M, Carlet J, Cassel J, Hill NS, Hinds CJ, Pimentel JM, Reinhart K, Thijs LG (2004) Challenges in end-of-life care in the ICU: statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003: executive summary. American Thoracic Society, European Respiratory Society; European Society of Intensive Care Medicine, Society of Critical Care Medicine, Societé de Réanimation de Langue Française Crit Care Med 32:1781–1784Google Scholar
  22. 22.
    Patrick DL, Danis M, Southerland LI, Hong G (1988) Quality of life after intensive care. J Gen Intern Med 3:218–223PubMedCrossRefGoogle Scholar
  23. 23.
    Bucquet D, Condon S, Ritchie K (1990) The French version of the Nottingham Health Profile: a comparison of items weights with those of the source version. Soc Sci Med 30:829–837CrossRefPubMedGoogle Scholar
  24. 24.
    Davis RB, Iezzoni Li, Phillips RS, Reiley P, Coffman GA, Safran C (1995) Predicting in-hospital mortality. The importance of functional status information. Med Care 33:906–921PubMedCrossRefGoogle Scholar
  25. 25.
    Boumendil A, Aegerter P, Guidet B. Cub-Rea Network (2005) Treatment intensity and outcome of patients aged 80 and older in intensive care units: a matched-cohort study. J Am Geriatr Soc 53:88–93CrossRefPubMedGoogle Scholar
  26. 26.
    Rady MY, Johnson DJ (2004) Hospital discharge to care facility. A patient-centered outcome for the evaluation of intensive care for octogenarians. Chest 126:1583–1591CrossRefPubMedGoogle Scholar
  27. 27.
    Azoulay E, Pochard F, Garrouste-Orgeas M, Moreau D, Montesino L, Adrie C, De Lassence A, Cohen Y, Timsit JF for the Outcomerea group (2003) Decisions to forgo life-sustaining therapy in ICU patients independently predicts hospital death. Intensive Care Med 29:1895–1901CrossRefPubMedGoogle Scholar
  28. 28.
    Cohen L, Lambrinos J (1995) Investigating the impact of age of mechanical ventilation using a population of 41848 patients from a statewide database. Chest 107:1673–1680PubMedCrossRefGoogle Scholar
  29. 29.
    Mayer-Oakes S, Oye R, Leake B (1991) Predictors of mortality in older patients following medical intensive care. J Am Geriatr Soc 39:862–868PubMedGoogle Scholar
  30. 30.
    Rosenthal GE, Kaboli PJ, Barnett MJ, Sirio CA (2002) Age and risk of in-hospital death: insights from a multihospital study of intensive care patients. J Am Geriatr Soc 50:1205–1212CrossRefPubMedGoogle Scholar
  31. 31.
    Wright JC, Plenderleith L, Ridley SA (2003) Long term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 58:637–642CrossRefPubMedGoogle Scholar
  32. 32.
    Niskanen M, Ruokonen E, Takala J, Rissanen P, Kari A (1999) Quality of care after prolonged intensive care. Crit Care Med 27:1132–1138CrossRefPubMedGoogle Scholar
  33. 33.
    Graf J, Koch M, Dujardin R, Kersten A, Janssens U (2003) Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med 31:2163–2169CrossRefPubMedGoogle Scholar
  34. 34.
    Nierman DM, Schechter CB, Cannon LM, Meier DE (2001) Outcome prediction model for very elderly critically ill patients. Crit Care Med 29:1853–1859CrossRefPubMedGoogle Scholar
  35. 35.
    Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonghe B, Carlet J (2000) Outcome, functional autonomy, and quality of life of elderly patients with a long term intensive care unit stay. Crit Care Med 28:3389–3395CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Maité Garrouste-Orgeas
    • 1
  • Jean-François Timsit
    • 2
  • Luc Montuclard
    • 3
  • Alain Colvez
    • 4
  • Olivier Gattolliat
    • 1
  • François Philippart
    • 1
  • Guillaume Rigal
    • 1
  • Benoit Misset
    • 1
  • Jean Carlet
    • 1
  1. 1.Medical ICUSaint Joseph HospitalParisFrance
  2. 2.Group of Epidemiology INSERM U-578 and Medical ICU Albert Michallon HospitalGrenobleFrance
  3. 3.Ethics DepartmentNecker HospitalParisFrance
  4. 4.Pole de Gerontologie and INSERMMontpellierFrance

Personalised recommendations