The study found that older people and those with chronic illnesses have the highest rates of end-of-life intensive care unit (ICU) use. Given that the country's aging population has an increasing prevalence of chronic diseases, the ICU may be treating more and more people at the end of life, the study's authors say.
Edward Seferian, M.D., a Mayo Clinic researcher, paediatric critical care physician and first author of the study, says the findings demonstrate the importance for patients to discuss their end-of-life treatment preferences with their physicians.
ICU care has been estimated at one percent of the U.S. gross domestic product and consumes 30 to 40 percent of hospital costs. While many factors affect intensive care use at the end of life, expanding alternative health care settings, such as nursing homes or hospice care, might be a more cost-effective use of federal health care funding, Seferian says.
The population-based study included 818 residents who had an ICU admission in 1998. Of those, one in five residents died having received ICU care in the last six months of life. Overall, those patients in their last year of life accounted for more than one-fourth of the ICU days used by Olmsted County, Minn., residents during the year. End-of-life ICU use for patients in other regions may be even greater, Seferian says, as evidenced by higher Medicare spending for inpatient care in other areas of the country. This study may increase policy makers' concerns, and those of the medical community, about increased demand on health resources by the country's aging population.
The proportion of ICU use by residents in their last year of life increased with advancing age. That's no surprise, but Seferian calls the degree to which this occurred "striking." People age 85 and older in their last year of life used 70 percent of ICU days among that age group, the study found.
MEDICA.de; Source: Mayo Clinic