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Intensive Care Medicine

, Volume 39, Issue 9, pp 1565–1573 | Cite as

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

  • F. Philippart
  • A. Vesin
  • C. Bruel
  • A. Kpodji
  • B. Durand-Gasselin
  • P. Garçon
  • M. Levy-Soussan
  • J. L. Jagot
  • N. Calvo-Verjat
  • J. F. Timsit
  • B. Misset
  • M. Garrouste-Orgeas
Original

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.

Keywords

Aged Frail elderly Patient preference Intensive care unit Triage Therapy ETHICA 

Notes

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.

Supplementary material

134_2013_2976_MOESM1_ESM.pdf (435 kb)
Supplementary material 1 (PDF 434 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • F. Philippart
    • 1
    • 2
  • A. Vesin
    • 3
  • C. Bruel
    • 1
  • A. Kpodji
    • 1
  • B. Durand-Gasselin
    • 4
  • P. Garçon
    • 5
  • M. Levy-Soussan
    • 6
  • J. L. Jagot
    • 7
  • N. Calvo-Verjat
    • 8
  • J. F. Timsit
    • 3
    • 9
    • 10
  • B. Misset
    • 1
    • 2
  • M. Garrouste-Orgeas
    • 1
    • 9
    • 11
  1. 1.Medical-Surgical, Saint Joseph Hospital NetworkParisFrance
  2. 2.René Descartes UniversityParisFrance
  3. 3.Department of BiostatisticsOutcomereaLa TroncheFrance
  4. 4.Geriatric Unit, Saint Joseph Hospital NetworkParisFrance
  5. 5.Cardiology Unit, Saint Joseph Hospital NetworkParisFrance
  6. 6.Palliative Care Unit, University Hospital La Pitié SalpétrièreParisFrance
  7. 7.Pulmonology Unit, Saint Joseph Hospital NetworkParisFrance
  8. 8.Gastrointestinal Surgery Unit, Saint Joseph Hospital NetworkParisFrance
  9. 9.Integrated Research Center U823 Epidemiology of Cancers and Severe Diseases, Albert Bonniot InstituteJoseph Fourier UniversityLa Tronche CedexFrance
  10. 10.Medical ICU, University Hospital Albert MichallonGrenobleFrance
  11. 11.Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint JosephParisFrance

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