Quality of life in patients aged 80 or over after intensive care unit discharge

Excerpt

In a recent issue of Critical Care, Tabah and colleagues [1] describe the quality of life after intensive care unit (ICU) discharge in octogenarians. The quality is not significantly decreased by ICU admission. This is good news and it is reassuring. There are old patients profiting from ICU admission without loss of quality of life. However, we have some concerns. Only 18 of 106 evaluated patients agreed to another ICU admission. Five did not agree, seven for various reasons refused evaluation, three had dementia, and 73 did not reach 1-year survival. So only the happy few were evaluated. What worries us are the feelings of the 86 patients and families that could not or did not agree to readmission. There is not much doubt that ICU admission causes suffering to patients and families. How can the suffering of 86 patients and families be balanced against the positive feelings of 18 patients? This is an ethical or philosophical dilemma that is not easy to solve and that is subject to large cultural differences. In a previous paper, the authors report that many octogenarians are already refused admission to the ICU [2]. We have to improve this triage model, not primarily to refuse more but to select better. A 1-year mortality rate of 70% is unacceptably high. Improvement should not be expected from better care but from better selection. Avoidance of unnecessary suffering and providing a good death can also mean tremendous improvement in the care of critically ill octogenarians. And it provides time and resources for improvement of care of those who will benefit. …