BACKGROUND: Dementia is a progressive terminal illness which requires decisions around aggressiveness of care. OBJECTIVE: The study objective was to examine the rate of intensive care unit (ICU) utilization and its regional variation among persons with both advanced cognitive and severe functional impairment. METHODS: We utilized the Minimum Data Set (MDS) to identify a cohort of decedents between 2000 and 2007 who (1) were in a nursing home (NH) 120 days prior to death and (2) had an MDS assessment indicating advanced cognitive and functional impairment as identified by cognitive performance scale (CPS) ≥5 and total dependence or extensive assistance in seven activities of daily living (ADLs). ICU utilization in the last 30 days of life was determined from Medicare claims files. A multivariate logistic regression model examined the likelihood of ICU admission in 2007 versus 2000 adjusting for sociodemographics, orders to limit life sustaining treatment, and health status. RESULTS: Among 474,829 Medicare NH residents with advanced cognitive impairment followed during 2000-2007, we observed an increase in ICU utilization from 6.1% in 2000 to 9.5% in 2007. After adjustment for sociodemographic characteristics, orders to limit life sustaining treatment, and measures of health status, the likelihood of a resident being admitted to an ICU was higher in 2007 compared to 2000 (adjusted odds ratio [OR] 1.71, 95% CI 1.60-1.81). Additionally, substantial regional variation was noted in ICU utilization, from 0.82% in Montana to 22% in the District of Columbia. CONCLUSIONS: Even among patients with advanced cognitive and functional impairment, ICU utilization in the last 30 days increased and varied by geographic region.
BACKGROUND: Dementia is a progressive terminal illness which requires decisions around aggressiveness of care. OBJECTIVE: The study objective was to examine the rate of intensive care unit (ICU) utilization and its regional variation among persons with both advanced cognitive and severe functional impairment. METHODS: We utilized the Minimum Data Set (MDS) to identify a cohort of decedents between 2000 and 2007 who (1) were in a nursing home (NH) 120 days prior to death and (2) had an MDS assessment indicating advanced cognitive and functional impairment as identified by cognitive performance scale (CPS) ≥5 and total dependence or extensive assistance in seven activities of daily living (ADLs). ICU utilization in the last 30 days of life was determined from Medicare claims files. A multivariate logistic regression model examined the likelihood of ICU admission in 2007 versus 2000 adjusting for sociodemographics, orders to limit life sustaining treatment, and health status. RESULTS: Among 474,829 Medicare NH residents with advanced cognitive impairment followed during 2000-2007, we observed an increase in ICU utilization from 6.1% in 2000 to 9.5% in 2007. After adjustment for sociodemographic characteristics, orders to limit life sustaining treatment, and measures of health status, the likelihood of a resident being admitted to an ICU was higher in 2007 compared to 2000 (adjusted odds ratio [OR] 1.71, 95% CI 1.60-1.81). Additionally, substantial regional variation was noted in ICU utilization, from 0.82% in Montana to 22% in the District of Columbia. CONCLUSIONS: Even among patients with advanced cognitive and functional impairment, ICU utilization in the last 30 days increased and varied by geographic region.
Authors: Mark Loeb; Soo Chan Carusone; Ron Goeree; Stephen D Walter; Kevin Brazil; Paul Krueger; Andrew Simor; Lorraine Moss; Thomas Marrie Journal: JAMA Date: 2006-06-07 Impact factor: 56.272
Authors: Joan M Teno; Susan L Mitchell; Sylvia K Kuo; Pedro L Gozalo; Ramona L Rhodes; Julie C Lima; Vincent Mor Journal: J Am Geriatr Soc Date: 2011-05-03 Impact factor: 5.562
Authors: Pedro Gozalo; Joan M Teno; Susan L Mitchell; Jon Skinner; Julie Bynum; Denise Tyler; Vincent Mor Journal: N Engl J Med Date: 2011-09-29 Impact factor: 91.245
Authors: Susan L Mitchell; Joan M Teno; Dan K Kiely; Michele L Shaffer; Richard N Jones; Holly G Prigerson; Ladislav Volicer; Jane L Givens; Mary Beth Hamel Journal: N Engl J Med Date: 2009-10-15 Impact factor: 91.245
Authors: Michael D Hurd; Paco Martorell; Adeline Delavande; Kathleen J Mullen; Kenneth M Langa Journal: N Engl J Med Date: 2013-04-04 Impact factor: 91.245
Authors: Christiane S Hartog; F Hoffmann; A Mikolajetz; S Schröder; A Michalsen; K Dey; R Riessen; U Jaschinski; M Weiss; M Ragaller; S Bercker; J Briegel; C Spies; D Schwarzkopf Journal: Anaesthesist Date: 2018-09-12 Impact factor: 1.041
Authors: Ana R Quiñones; Susan L Mitchell; Jonathan D Jackson; María P Aranda; Peggye Dilworth-Anderson; Ellen P McCarthy; Ladson Hinton Journal: J Am Geriatr Soc Date: 2020-07 Impact factor: 5.562
Authors: Mairead M Bartley; Laura Suarez; Reem M A Shafi; Joshua M Baruth; Amanda J M Benarroch; Maria I Lapid Journal: Curr Psychiatry Rep Date: 2018-06-23 Impact factor: 5.285
Authors: Daniel E Lage; Clark DuMontier; Yoojin Lee; Ryan D Nipp; Susan L Mitchell; Jennifer S Temel; Areej El-Jawahri; Sarah D Berry Journal: Cancer Date: 2019-12-20 Impact factor: 6.860