The study of more than one million Medicare beneficiaries nationwide found that a person over age 90 was one-third as likely as someone ages 68-70 of the same race, gender, income and illness category to receive care in an intensive or critical care unit.
"The concern this study raises is whether some older people are not getting care that might help them," said lead researcher Theodore Iwashyna, M.D., Ph.D., of the Hospital of the University of Pennsylvania, Philadelphia. "While previous studies have shown that older people are more likely to have 'Do Not Resuscitate' orders, it may be that physicians or family members assume that older people don't want aggressive care in general, and that may not be true. It also suggests that younger patients may be getting more aggressive care than they might really want." Treatment in an ICU appears to be just as effective for an 85-year-old as for a 65-year-old, Dr. Iwashyna noted.
For lung cancer patients, 47.6% of those aged 68-70 used critical care at some point, compared with only 25% of those ages 86-90 and 20.7% of those over age 90. This pattern was similar for all disease categories studied, including heart attack, stroke, hip fracture, congestive heart failure, leukemia and lymphoma. For heart attack patients, those ages 86-90 are 75% less likely to be cared for in an ICU compared with those ages 68-70; those over age 90 are 85% less likely to use an ICU than those 68-70. Stroke patients age 86-90 are 57% less likely to use critical care than those 68-70; those over 90 are 72.5% less likely to be cared for in an ICU than those in the 68-70 age group.
During the five-year period included in the study, 54.9% of the 1.1 million Medicare beneficiaries received some type of critical care. "That means that many, many elderly Americans will end up in an ICU at some point," Dr. Iwashyna said. "So no one can say that it's unlikely to happen to them. That's why it is so important for everyone to have a conversation with their physician and their family about what kind of care they want in the event they become seriously ill - and to think hard about these tough questions themselves. Otherwise, you'll be making your family members and physicians guess what you would want, and they may guess wrong."