The ETHICA study (part I): elderly’s thoughts about intensive care unit admission for life-sustaining treatments
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To assess preferences among individuals aged ≥80 years for a future hypothetical critical illness requiring life-sustaining treatments.
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.
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.
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.
KeywordsAged Frail elderly Patient preference Intensive care unit Triage Therapy ETHICA
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.
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