Limitation of therapeutic activity in elderly critically ill patients

OBJECTIVE To establish whether the age of patients admitted into the intensive care unit (ICU) influences the amount of therapy received. DESIGN Observational, prospective, multicenter study. SETTING Eighty-six multidisciplinary ICUs in Spain, including coronary patients. PATIENTS The patients (n = 8,838) were studied during a 6-month period between 1992 and 1993. Patients 75 yrs of age. Compared with younger patients, these patients had higher APACHE II (18.41 +/- 0.23 vs. 15.14 +/- 0.09 points, p < .001) and APACHE III (65.8 +/- 0.81 vs. 53.32 +/- 0.33 points, p < .001) scores, a higher quality of life survey score (i.e., worse quality of life, 7.19 +/- 0.19 vs. 3.86 +/- 0.05 points, p < .001), and a greater ICU mortality rate (21.9% vs. 15.3%, p < .00001) and hospital mortality rate (30.8% vs. 19.3%, p < .00001). However, patients >75 yrs had a lower Therapeutic Intervention Scoring System score (19.83 +/- 0.28 vs. 21.17 +/- 0.12 points, p < .001). Multivariate analysis showed that once severity, need for mechanical ventilation, diagnostic group, and mortality rate were taken into account, there was less therapeutic activity in patients >75 yrs of age. CONCLUSIONS Patients >75 yrs of age represent a large proportion of patients in Spanish ICUs. Although their mortality rate and severity scores were higher than those values in younger patients, patients >75 yrs of age received less therapy. (Crit Care Med 1997; 25:1643-1648)