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Gériatrie et Psychologie Neuropsychiatrie du Vieillissement

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Criteria of early limitation of transfer in intensive care unit of patients aged 75 and over hospitalized in an acute geriatric unit Volume 19, issue 3, Septembre 2021

Authors
CHU Dijon Bourgogne, Pôle personnes âgées, Service de médecine interne gériatrie, Dijon
* Correspondance

Objective

Because of heterogeneity of the elderly population and medical practices, the decision of admission of elderly patients (EP) in intensive care unit is more complex. This study aimed to determine the decision criteria for an early limitation of transfer in intensive care unit (ELTICU) of patients hospitalized in an acute geriatric unit.

Methods

This retrospective study included, over a 10-month period, patients ≥75 years and hospitalized in an acute geriatric unit. They were divided into 2 groups according to whether or not an ELTICU decision was taken.

Results

In total, 906 EP were included among them 446 with no ELTICU decision. Univariate analysis showed a correlation between ELTICU and a Mini Mental Status score of less than 20/30. Malnutrition had no impact on ELTICU decision. In multivariate analysis, the factors associated with an ELTICU decision were an age ≥ 85 years, an hospitalization in the last 6 months (Odds Ratio (OR) = 1.72, Confidence Interval (CI) 95% [1.23-2.39]), life in a nursing home (OR = 1.93, 95% CI [1.18-3.16]) and the presence of bedsore(s) (OR = 2.44, 95% CI [1.20-4.98]). A null Charlson score was associated with the absence of an ELTICU decision (OR = 0.42, 95% CI [0.26-0.67]).

Conclusion

Some criteria are shared between geriatricians, resuscitators and emergency physicians, while others are discordant, illustrating differences in physicians’ practices.