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Factors that influence intensive care admission decisions for older people: A systematic review

  • Chloe Foley
    Correspondence
    Corresponding author at: Latrobe Regional Hospital, 10 Village Avenue, Traralgon, VIC, 3844, Australia.
    Affiliations
    Latrobe Regional Hospital, 10 Village Avenue, Traralgon, VIC, 3844, Australia

    School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
    Search for articles by this author
  • Melissa Bloomer
    Affiliations
    School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia

    Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
    Search for articles by this author
  • Alison M. Hutchinson
    Affiliations
    School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia

    Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia

    Monash Health, Centre for Quality and Patient Safety Research, Monash Health Partnership, 246 Clayton Road, Clayton, VIC, 3168, Australia
    Search for articles by this author
Published:February 07, 2022DOI:https://doi.org/10.1016/j.aucc.2021.12.006

      Abstract

      Background

      The population worldwide is rapidly ageing, and demand for intensive care is increasing. People aged 85 years and above, known as the oldest old, are particularly vulnerable to critical illness owing to the physiological effects of ageing. Evidence surrounding admission of the oldest old to the intensive care is limited.

      Objective

      The objective of this study was to systematically and comprehensively review and synthesise the published research investigating factors that influence decisions to admit the oldest old to the intensive care unit.

      Method

      This was a systematic review and narrative synthesis. Following a comprehensive search of CINAHL, Embase, and Medline databases, peer-reviewed primary research articles examining factors associated with admission or refusal to admit the oldest old to intensive care were selected. Data were extracted into tables and narratively synthesised.

      Results

      Six studies met the inclusion criteria. Three studies identified factors associated with admission such as greater premorbid self-sufficiency, patient preferences, alignment between patient and physicians’ goals of treatment, age less than 85 years, and absence of cancer, or previous intensive care admission. Factors associated with refusal to admit were identified in all six studies and included limited or no bed availability, level of ICU physician experience, patients being deemed too ill or too well to benefit, and older age.

      Conclusions

      Published research investigating decision-making about admission or refusal to admit the oldest old to the intensive care unit is scant. The ageing population and increasing demand for intensive care unit resources has amplified the need for greater understanding of factors that influence decisions to admit or refuse admission of the oldest old to the intensive care unit. Such knowledge may inform guidelines regarding complex practice decisions about admission of the oldest old to an intensive care unit. Such guidelines would ensure the specialty needs of this population are considered and would reduce admission decisions that might disadvantage older people.

      Keywords

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