[Out-of-hospital assessment of elderly patients' preference for ICU care]

Abstract

Objective: To estimate the adequacy between elderly patients' preference for ICU care when treated for a life-threatening pathology, and the strategy proposed by the medical team on scene.

Study design: Prospective, observational study.

Patients and methods: All patients older than 80 treated out-of-hospital for a life threatening pathology were included, except in case of language barrier, or when patients were unable to answer and absence of next-of-kin. The results of the questionnaire on quality of life and patients' preference concerning ICU care were compared to the responses provided blindly by the medical team.

Results: Fifty-five patients were included. Quality of life as expressed by the patients was 7 (5-10) and by the physician 7 (6-8) (P=0.69). Thirty-six patients (65%) expressed the wish to be resuscitated, while ICU admission would have been proposed for 44 patients (80%) by the doctors (P=0.01). Among the 14 patients reluctant to ICU admission, 11 would have been proposed for ICU admission. In multivariate analysis, age (OR: 1.55 [1.04-2.32], P=0.03) and history of neurological pathology (OR: 11,91 [5.68->100], P=0.04) were associated with such an inadequacy.

Conclusion: The inadequacy between elderly patients' preferences and doctors' opinion concerning ICU cares is frequent. The present results support a more systematic collection of patients' preferences when treated on scene for a life-threatening pathology.