Effect of advance directives on the management of elderly critically ill patients.
To evaluate the effects of advance directives on the management of elderly, critically ill patients.
Retrospective chart review.
Teaching hospital medical/surgical, noncardiac intensive care unit (ICU).
The medical records of 401 patients, =65 yrs of age, admitted to the ICU between 1992 and 1995 were reviewed.
Measurements and Main Results
Advance directive statements included refusal of cardiopulmonary resuscitation (CPR), nutrition, intravenous medications, antibiotics, mechanical ventilation, and blood products.
Nineteen (5%) patients had advance directives (study group).
These patients were compared with 28 case-matched (age, Acute Physiology and Chronic Health Evaluation II score, and diagnosis) critically ill patients without advance directives (control group).
We compared the following data
Cost per day ; number of surgical procedures ; number of radiographic studies ; number of central venous and pulmonary artery catheter insertions ; number of complete blood counts, electrolytes, and cultures sent for laboratory testing ; number of days in the ICU/hospital ; and mortality rates.
Statistical analysis was performed using the Student's t-test for independent means and the chi-square equation.
For all observed parameters, quantitative and dichotomous differences between study and control groups were not statistically significant. (...)
Mots-clés Pascal : Malade état grave, Soin intensif, Réanimation, Coût, Désir, Malade, Demande thérapeutique, Etude comparative, Ethique, Conduite à tenir, Gériatrie, Vieillard, Homme, Economie santé, Refus traitement, Droits malade
Mots-clés Pascal anglais : Critically ill, Intensive care, Resuscitation, Costs, Desire, Patient, Therapeutical request, Comparative study, Ethics, Clinical management, Geriatrics, Elderly, Human, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0238188
Code Inist : 002B31. Création : 11/09/1998.