The following is a summary of “Outcomes in Patients Perceived as Receiving Excessive Care by ICU Physicians and Nurses: Differences Between Patients < 75 and ≥ 75 Years of Age?” published in the September 2023 issue of CHEST by Piers, et al.
ICU use is controversial when it comes to elderly individuals. When paired with objective patient data, ICU nurses’ and doctors’ subjective views of excessive care must be better understood. Is there a disparity between patients younger than 75 and older than 75 years old, with and without concordant judgments of excessive care by two or more ICU nurses and doctors, regarding treatment-limiting choices and 1-year outcomes? This was a reanalysis of the DISPROPRICUS research conducted in 56 intensive care units as a prospective observational study. Over the course of 28 days in 2014, nurses and doctors filled out a questionnaire about the appropriateness of treatment for each of their patients. Cox regression with propensity score weighting and Fisher exact tests were used to compare the cumulative incidence of patients with concordant perceptions of excessive care, treatment limitation decisions, and the proportion of patients attaining the combined endpoint (death, poor quality of life, or not being at home) at 1 year across age groups.
About 405 out of 1,641 patients (or 25%) were seniors aged 75 and more. Congruent reports of unnecessary treatment were more common among the elderly (13.6% vs. 8.5%; P <.001). The risk of death, treatment limitation decisions (33% vs. 31%; HR after weighting, 1.11; 95% CI, 0.74-1.65), and reaching the combined endpoint at 1 year (90% vs. 93%; P =.546) were all similar between the two oldest age groups in patients with concordant perceptions of excessive care. Treatment limitation decisions were more common in patients with discordant perceptions of excessive care (11% vs. 5%; P< .001; HR, 2.11; 95% CI, 1.37-3.27), and these decisions were mostly documented before the patient was admitted to the intensive care unit. Older people were more likely to attain the combined end goal (61.6% vs. 52.8%; P <.001).
Even while older patients have a somewhat greater prevalence of excessive care perceptions, once concordant perceptions of excessive care identify individuals, there is no difference in treatment limitation choices or 1-year outcomes between older and younger patients. Also, older persons have poorer outcomes when nurses and doctors in the intensive care unit have a different understanding of their conditions.