LIMITATION OF THERAPEUTIC ACTIVITY IN ELDERLY CRITICALLY ILL PATIENTS

Objective: To establish whether the age of patients admitted into the intensive care unit (ICU) influences the amount of therapy received. D esign: Observational, prospective, multicenter study. Setting: Eighty- six multidisciplinary ICUs in Spain, including coronary patients. Pati ents: The patients (n = 8,838) were studied during a 6-month period be tween 1992 and 1993. Patients <16 yrs of age and patients dying within the first 6 hrs were excluded from the study. Measurements and Main R esults: We collected data on age, gender, type of diagnosis at the tim e of admission, severity level by Acute Physiology and Chronic Health Evaluation (APACHE) II and III, quality of life survey score, therapeu tic activity during the first 24 hrs by Therapeutic Intervention Scori ng System, and ICU and hospital mortality rates. In the sample of pati ents, 12.5% were >75 yrs of age. Compared with younger patients, these patients had higher APACHE II (18.41 +/- 0.23 vs. 15.14 +/- 0.09 poin ts, p < .001) and APACHE III (65.8 +/- 0.81 vs. 53.32 +/- 0.33 points, p < .001) scores, a higher quality of life survey score (i.e., worse quality of life, 7.19 +/- 0.19 vs. 3.86 +/- 0.05 points, p < .001), an d a greater ICU mortality rate (21.9% vs. 15.3%, p < .00001) and hospi tal mortality rate (30.8% vs. 19.3%, p < .00001). However, patients >7 5 yrs had a lower Therapeutic Intervention Scoring System score (19.83 +/- 0.28 vs. 21.17 +/- 0.12 points, p < .001). Multivariate analysis showed that once severity, need for mechanical ventilation, diagnostic group, and mortality rate were taken into account, there was less the rapeutic activity in patients >75 yrs of age. Conclusions: Patients >7 5 yrs of age represent a large proportion of patients in Spanish ICUs. Although their mortality rate and severity scores were higher than th ose values in younger patients, patients >75 yrs of age received less therapy.