RATIONALE: Adults with chronic critical illness (tracheostomy after ≥ 10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-acute care facilities. OBJECTIVES: To determine whether older ICU survivors discharged to post-acute care facilities have potentially unmet palliative care needs. METHODS: We examined electronic records from a 1-year cohort of 228 consecutive adults ≥ 65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. MEASUREMENTS AND MAIN RESULTS: The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%. CONCLUSIONS: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.
RATIONALE: Adults with chronic critical illness (tracheostomy after ≥ 10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-acute care facilities. OBJECTIVES: To determine whether older ICU survivors discharged to post-acute care facilities have potentially unmet palliative care needs. METHODS: We examined electronic records from a 1-year cohort of 228 consecutive adults ≥ 65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. MEASUREMENTS AND MAIN RESULTS: The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%. CONCLUSIONS: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.
Authors: Derek C Angus; Andrew F Shorr; Alan White; Tony T Dremsizov; Robert J Schmitz; Mark A Kelley Journal: Crit Care Med Date: 2006-04 Impact factor: 7.598
Authors: Paul N Lanken; Peter B Terry; Horace M Delisser; Bonnie F Fahy; John Hansen-Flaschen; John E Heffner; Mitchell Levy; Richard A Mularski; Molly L Osborne; Thomas J Prendergast; Graeme Rocker; William J Sibbald; Benjamin Wilfond; James R Yankaskas Journal: Am J Respir Crit Care Med Date: 2008-04-15 Impact factor: 21.405
Authors: Anita K Wagner; Fang Zhang; Stephen B Soumerai; Alexander M Walker; Jerry H Gurwitz; Robert J Glynn; Dennis Ross-Degnan Journal: Arch Intern Med Date: 2004-07-26
Authors: Matthew R Baldwin; Wazim R Narain; Hannah Wunsch; Neil W Schluger; Joseph T Cooke; Mathew S Maurer; John W Rowe; David J Lederer; Peter B Bach Journal: Chest Date: 2013-04 Impact factor: 9.410
Authors: Lauren R Pollack; Nathan E Goldstein; Wendy C Gonzalez; Craig D Blinderman; Mathew S Maurer; David J Lederer; Matthew R Baldwin Journal: J Am Geriatr Soc Date: 2017-03-06 Impact factor: 5.562
Authors: K Adler; D Schlieper; D Kindgen-Milles; S Meier; J Schwartz; P van Caster; M S Schaefer; M Neukirchen Journal: Anaesthesist Date: 2017-06-06 Impact factor: 1.041
Authors: Daniel E Lage; Ryan D Nipp; Sara M D'Arpino; Samantha M Moran; P Connor Johnson; Risa L Wong; William F Pirl; Ephraim P Hochberg; Lara N Traeger; Vicki A Jackson; Barbara J Cashavelly; Holly S Martinson; Joseph A Greer; David P Ryan; Jennifer S Temel; Areej El-Jawahri Journal: J Clin Oncol Date: 2017-10-25 Impact factor: 44.544
Authors: Christopher E Cox; Maren K Olsen; David Casarett; Krista Haines; Mashael Al-Hegelan; Raquel R Bartz; Jason N Katz; Colleen Naglee; Deepshikha Ashana; Daniel Gilstrap; Jessie Gu; Alice Parish; Allie Frear; Deepthi Krishnamaneni; Andrew Corcoran; Sharron L Docherty Journal: Contemp Clin Trials Date: 2020-09-29 Impact factor: 2.226