Aged, 80 and Over, Critical Illness
Conditions
Keywords
consent, goals of treatment, proxy accuracy, shared decision making
Brief summary
Do very elderly adults wish intensive care in the event of acute life-threatening illness and are their next of kin able to predict these preferences? Very elderly patients are a steeply increasing patient population in intensive care units (ICUs), but the overall benefit of intensive care for these patients remains controversial. Will ICU admission improve survival and quality of life, or will it prolong suffering and delay natural death? Little is known about very elderly Norwegians life sustaining treatment (LST) preferences in these situations where treatment benefit is uncertain. This project aims to improve critically ill very elderly patients' ICU trajectories by bringing forth knowledge about their treatment preferences, their family members' ability to predict these preferences, and by directing attention to the challenges of consent to critical care in cases of medical uncertainty. A selv administered, mailed survey will be distributed among 400 outpatients aged 80 years or older and their next of kin. Respondents will be recruited at the ophthalmologic, ear-nose-and-throat and orthopaedic outpatient clinics at Haukeland University Hospital Bergen, Norway. The investigators developed and validated a survey tool for this purpose, containing 3 hypothetical scenarios of acute life-threatening illness. The scenarios are randomly chosen from 20 hypothetical patient histories and are representative for ICU admission diagnoses in Norway and Europe. The participants will be asked for treatment choices, i.e. wishing admission to intensive care or not. A response option 'not wishing to engage in the treatment decision' is also provided. Furthermore, the questionnaire includes factors that may influence elderlies' treatment preferences and proxies' ability to predict these preferences including: demographics, religion, previous experience with and / or communication about critical illness, comorbidity, frailty, quality of life, and projections (i.e. the proxy's own treatment preferences). The respondents are requested to explain their choices by free-text comments after each scenario. They are also asked to elaborate how they wish next-of-kin should contribute to decision making in these cases. Additional space for free-text comments is provided in the end of the questionnaire. The study design is exploratory. Responses will be analysed with both quantitative statistics and qualitative methods.
Interventions
OTHERsurvey Intensive care of very elderly: What do they wish for themselves?
self-administered mailed survey
Sponsors
University of Bergen
Haukeland University Hospital
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
80 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Outpatients aged 80 years or older who register for appointment at the ophthalmologic, ear-nose-and-throat, and orthopaedic outpatient clinic at Haukeland University Hospital, Bergen, Norway.
Exclusion criteria
1. not consenting to participate 2. living in permanent care facility / nursing home 3. not able to complete the questionnaire owing to: * severely reduced vision / blindness * high degree of frailty (Clinical frailty scale ≥ 7) * cognitive impairment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | within 2 weeks of recruitment / upon completion of the questionnaire | Three mutually exclusive answer options in three randomly assigned clinically scenarios of acute critical illness in advanced age 1. Wishing ICU admission 2. Not wishing ICU admission 3. Not wanting to decide |
Countries
Norway
Participant flow
Pre-assignment details
1043 very old outpatients were approached. The next-of-kin respondents were recruited by the enrolled very old respondents.
Participants by arm
| Arm | Count |
|---|---|
| Very Elderly Outpatients outpatients (eyes, ear-nose-and throat, orthopaedic outpatient clinics at Haukeland University Hospital, Bergen, Norway) aged 80 years and older
survey Intensive care of very elderly: What do they wish for themselves?: self-administered mailed survey | 202 |
| Proxy next of kin who likely would act as a proxy in a medical emergency, identified by the very elderly respondent
survey Intensive care of very elderly: What do they wish for themselves?: self-administered mailed survey | 153 |
| Total | 355 |
Baseline characteristics
| Characteristic | Very Elderly Outpatients | Proxy | Total |
|---|---|---|---|
| Age, Continuous Age, Continuous (very old outpatients) | 86 years STANDARD_DEVIATION 3.9 | 66 years STANDARD_DEVIATION 13.3 | 82.8 years STANDARD_DEVIATION 9.1 |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Sex: Female, Male Female | 102 Participants | 116 Participants | 218 Participants |
| Sex: Female, Male Male | 100 Participants | 37 Participants | 137 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 202 | 0 / 153 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy
Three mutually exclusive answer options in three randomly assigned clinically scenarios of acute critical illness in advanced age 1. Wishing ICU admission 2. Not wishing ICU admission 3. Not wanting to decide
Time frame: within 2 weeks of recruitment / upon completion of the questionnaire
| Arm | Measure | Category | Value (COUNT_OF_UNITS) |
|---|---|---|---|
| Very Elderly Outpatients | Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | Wishing ICU admission | 228 Treatment preference statement |
| Very Elderly Outpatients | Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | Not wishing ICU admission | 238 Treatment preference statement |
| Very Elderly Outpatients | Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | Not wanting to decide | 124 Treatment preference statement |
| Proxy | Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | Wishing ICU admission | 231 Treatment preference statement |
| Proxy | Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | Not wishing ICU admission | 154 Treatment preference statement |
| Proxy | Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | Not wanting to decide | 68 Treatment preference statement |