The Impact of Age on Utilization of Intensive Care Resources

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Abstract
The impact of age on admission practices and pattern of care were examined in 599 admissions to a medical intensive care unit (MICU) and 290 patients on the conventional medical care divisions of the same hospital. Four age groups were compared: under 55, 55 to 64, 65 to 74, and 75 years of age and over. Severity of illness and prior health were assessed using the Acute Physiology Score (APS) and the Chronic Health Evaluation (CHE) instruments. Resource utilization was assessed using the Therapeutic Intervention Scoring System (TISS) and hospital charges.Patients 65 years of age and over comprised 48% of the MICU sample. The distribution of CHE was different among the four groups. Twenty‐one percent of patients under 55 years of age had no prior chronic illness, as compared to less than 8% of older patients. The APS at admission was similar for all age groups, as was admission, daily, and total TISS. Hospital survival declined with age from 85% to 70%, while the likelihood of being designated do not resuscitate (DNR) increased from 10% to 24%. Differences in hospital survival disappeared when controlling for severity of illness and prior health, but differences in DNR status did not. Still, elderly DNR patients received as much resources as younger DNR patients and this was more than non‐DNR patients.The sample of patients treated on conventional medical divisions had age distribution similar to the MICU sample. There was some evidence that admission APS (median, 5, 5, 6, 6, respectively, P = .055) and maximum APS (median, 5, 5, 7, 8, respectively, P = .023) differed slightly across age groups. Yet elderly patients admitted to the MICU from the divisions were no sicker than younger patients (median, 19.0, 17.0, 17.5, 18.0, P = .9713). We conclude that there were no selective barriers restricting access of the elderly to the MICU and that once admitted to the MICU, treatment patterns differed only in the application of DNR status. J Am Geriatr Soc 35:983–988, 1987