Use of aggressive medical treatments near the end of life: differences between patients with and without dementia.
Identifieur interne : 001998 ( Main/Exploration ); précédent : 001997; suivant : 001999Use of aggressive medical treatments near the end of life: differences between patients with and without dementia.
Auteurs : Samuel S. Richardson [États-Unis] ; Greer Sullivan ; Ariel Hill ; Wei YuSource :
- Health services research [ 0017-9124 ] ; 2007.
Descripteurs français
- KwdFr :
- Department of Veterans Affairs (USA) (organisation et administration), Démence (MeSH), Femelle (MeSH), Humains (MeSH), Medicare (USA) (MeSH), Mâle (MeSH), Populations d'origine continentale (MeSH), Services de santé (statistiques et données numériques), Soins terminaux (organisation et administration), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), États-Unis (MeSH), Études rétrospectives (MeSH).
- MESH :
- organisation et administration : Department of Veterans Affairs (USA), Soins terminaux.
- statistiques et données numériques : Services de santé.
- Démence, Femelle, Humains, Medicare (USA), Mâle, Populations d'origine continentale, Sujet âgé, Sujet âgé de 80 ans ou plus, États-Unis, Études rétrospectives.
English descriptors
- KwdEn :
- Aged (MeSH), Aged, 80 and over (MeSH), Continental Population Groups (MeSH), Dementia (MeSH), Female (MeSH), Health Services (statistics & numerical data), Humans (MeSH), Male (MeSH), Medicare (MeSH), Retrospective Studies (MeSH), Terminal Care (organization & administration), United States (MeSH), United States Department of Veterans Affairs (organization & administration).
- MESH :
- organization & administration : Terminal Care, United States Department of Veterans Affairs.
- statistics & numerical data : Health Services.
- Aged, Aged, 80 and over, Continental Population Groups, Dementia, Female, Humans, Male, Medicare, Retrospective Studies, United States.
Abstract
OBJECTIVE
To analyze whether acute care patients with dementia are more or less likely to receive each of five aggressive medical services near the end of life, compared with patients without dementia.
DATA SOURCES
Two years of Veterans Affairs (VA) and Medicare utilization data for all 169,036 VA users nationwide age 67 and older who died between October 1, 1999 and September 30, 2001.
STUDY DESIGN
We performed a retrospective analysis of acute care stays discharged in the final 30 days of life. The main outcome measure was the patient's likelihood of receiving each of five aggressive services (intensive care unit [ICU] admission, ventilator, cardiac catheterization, pulmonary artery monitor, and dialysis), controlling for demographic and clinical factors in probit regressions.
PRINCIPAL FINDINGS
There were 122,740 acute-stay discharges during the final 30 days of life, representing 94,100 unique patients (31,654 with dementia). In probit models comparing acute care patients with and without dementia, patients with dementia were 7.5 percentage points less likely to be admitted to the ICU (95 percent confidence interval [CI], 6.9-8.1; percent of stays with ICU admission=36.8 percent), 5.4 percentage points less likely to be placed on a ventilator (95 percent CI, 5.0-5.9; percent of stays with ventilator use=17.1 percent), 0.7 percentage points less likely to receive cardiac catheterization (95 percent CI, 0.6-0.8; percent of stays with cardiac catheterization=2.7 percent), 1.4 percentage points less likely to receive pulmonary artery monitoring (95 percent CI, 1.2-1.5; percent of stays with pulmonary artery monitoring=2.6 percent), and 0.6 percentage points less likely to receive dialysis (95 percent CI, 0.4-0.8; percent of stays with dialysis=4.6 percent).
CONCLUSIONS
During the final 30 days of life, acute care patients with dementia are treated substantially less aggressively than patients without dementia. Further research is warranted to determine the causes and appropriateness of these patterns of care.
DOI: 10.1111/j.1475-6773.2006.00608.x
PubMed: 17355588
PubMed Central: PMC1955744
Affiliations:
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Richardson</name><affiliation wicri:level="2"><nlm:affiliation>VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA 94025</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Sullivan, Greer" sort="Sullivan, Greer" uniqKey="Sullivan G" first="Greer" last="Sullivan">Greer Sullivan</name></author><author><name sortKey="Hill, Ariel" sort="Hill, Ariel" uniqKey="Hill A" first="Ariel" last="Hill">Ariel Hill</name></author><author><name sortKey="Yu, Wei" sort="Yu, Wei" uniqKey="Yu W" first="Wei" last="Yu">Wei Yu</name></author></analytic><series><title level="j">Health services research</title><idno type="ISSN">0017-9124</idno><imprint><date when="2007" type="published">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Continental Population Groups (MeSH)</term><term>Dementia (MeSH)</term><term>Female (MeSH)</term><term>Health Services (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Medicare (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>Terminal Care (organization & administration)</term><term>United States (MeSH)</term><term>United States Department of Veterans Affairs (organization & administration)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Department of Veterans Affairs (USA) (organisation et administration)</term><term>Démence (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Medicare (USA) (MeSH)</term><term>Mâle (MeSH)</term><term>Populations d'origine continentale (MeSH)</term><term>Services de santé (statistiques et données numériques)</term><term>Soins terminaux (organisation et administration)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term><term>États-Unis (MeSH)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" qualifier="organisation et administration" xml:lang="fr"><term>Department of Veterans Affairs (USA)</term><term>Soins terminaux</term></keywords><keywords scheme="MESH" qualifier="organization & administration" xml:lang="en"><term>Terminal Care</term><term>United States Department of Veterans Affairs</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Health Services</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Services de santé</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Continental Population Groups</term><term>Dementia</term><term>Female</term><term>Humans</term><term>Male</term><term>Medicare</term><term>Retrospective Studies</term><term>United States</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Démence</term><term>Femelle</term><term>Humains</term><term>Medicare (USA)</term><term>Mâle</term><term>Populations d'origine continentale</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>États-Unis</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To analyze whether acute care patients with dementia are more or less likely to receive each of five aggressive medical services near the end of life, compared with patients without dementia.</p></div><div type="abstract" xml:lang="en"><p><b>DATA SOURCES</b></p><p>Two years of Veterans Affairs (VA) and Medicare utilization data for all 169,036 VA users nationwide age 67 and older who died between October 1, 1999 and September 30, 2001.</p></div><div type="abstract" xml:lang="en"><p><b>STUDY DESIGN</b></p><p>We performed a retrospective analysis of acute care stays discharged in the final 30 days of life. The main outcome measure was the patient's likelihood of receiving each of five aggressive services (intensive care unit [ICU] admission, ventilator, cardiac catheterization, pulmonary artery monitor, and dialysis), controlling for demographic and clinical factors in probit regressions.</p></div><div type="abstract" xml:lang="en"><p><b>PRINCIPAL FINDINGS</b></p><p>There were 122,740 acute-stay discharges during the final 30 days of life, representing 94,100 unique patients (31,654 with dementia). In probit models comparing acute care patients with and without dementia, patients with dementia were 7.5 percentage points less likely to be admitted to the ICU (95 percent confidence interval [CI], 6.9-8.1; percent of stays with ICU admission=36.8 percent), 5.4 percentage points less likely to be placed on a ventilator (95 percent CI, 5.0-5.9; percent of stays with ventilator use=17.1 percent), 0.7 percentage points less likely to receive cardiac catheterization (95 percent CI, 0.6-0.8; percent of stays with cardiac catheterization=2.7 percent), 1.4 percentage points less likely to receive pulmonary artery monitoring (95 percent CI, 1.2-1.5; percent of stays with pulmonary artery monitoring=2.6 percent), and 0.6 percentage points less likely to receive dialysis (95 percent CI, 0.4-0.8; percent of stays with dialysis=4.6 percent).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>During the final 30 days of life, acute care patients with dementia are treated substantially less aggressively than patients without dementia. Further research is warranted to determine the causes and appropriateness of these patterns of care.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">17355588</PMID><DateCompleted><Year>2007</Year><Month>04</Month><Day>05</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>01</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0017-9124</ISSN><JournalIssue CitedMedium="Print"><Volume>42</Volume><Issue>1 Pt 1</Issue><PubDate><Year>2007</Year><Month>Feb</Month></PubDate></JournalIssue><Title>Health services research</Title><ISOAbbreviation>Health Serv Res</ISOAbbreviation></Journal><ArticleTitle>Use of aggressive medical treatments near the end of life: differences between patients with and without dementia.</ArticleTitle><Pagination><MedlinePgn>183-200</MedlinePgn></Pagination><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To analyze whether acute care patients with dementia are more or less likely to receive each of five aggressive medical services near the end of life, compared with patients without dementia.</AbstractText><AbstractText Label="DATA SOURCES" NlmCategory="METHODS">Two years of Veterans Affairs (VA) and Medicare utilization data for all 169,036 VA users nationwide age 67 and older who died between October 1, 1999 and September 30, 2001.</AbstractText><AbstractText Label="STUDY DESIGN" NlmCategory="METHODS">We performed a retrospective analysis of acute care stays discharged in the final 30 days of life. The main outcome measure was the patient's likelihood of receiving each of five aggressive services (intensive care unit [ICU] admission, ventilator, cardiac catheterization, pulmonary artery monitor, and dialysis), controlling for demographic and clinical factors in probit regressions.</AbstractText><AbstractText Label="PRINCIPAL FINDINGS" NlmCategory="RESULTS">There were 122,740 acute-stay discharges during the final 30 days of life, representing 94,100 unique patients (31,654 with dementia). In probit models comparing acute care patients with and without dementia, patients with dementia were 7.5 percentage points less likely to be admitted to the ICU (95 percent confidence interval [CI], 6.9-8.1; percent of stays with ICU admission=36.8 percent), 5.4 percentage points less likely to be placed on a ventilator (95 percent CI, 5.0-5.9; percent of stays with ventilator use=17.1 percent), 0.7 percentage points less likely to receive cardiac catheterization (95 percent CI, 0.6-0.8; percent of stays with cardiac catheterization=2.7 percent), 1.4 percentage points less likely to receive pulmonary artery monitoring (95 percent CI, 1.2-1.5; percent of stays with pulmonary artery monitoring=2.6 percent), and 0.6 percentage points less likely to receive dialysis (95 percent CI, 0.4-0.8; percent of stays with dialysis=4.6 percent).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">During the final 30 days of life, acute care patients with dementia are treated substantially less aggressively than patients without dementia. 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