High-Intensity Care for Nursing Home Residents with Severe Dementia Hospitalized at the End of Life: A Mixed Methods Study.
Andrew B Cohen, William M McDonald, John R O'Leary and 2 others
PMID 38462230WHAT IT FOUND
The most common path to ICU care was family uncertainty (18 of 41); 15 patients received reflexive protocol-based ICU care.
Check directives and surrogates before emergency transfer.
Key findings
01Forty-one patients received ICU care, and 15 underwent mechanical ventilation.
02The most common path was family members initially favoring high-intensity treatment and later limiting care (18 of 41).
03Fifteen patients received high-intensity care reflexively, with family conversations occurring only after ICU admission or intubation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The final sample was only 41 patients from 28 VA hospitals, so the pathways may not represent all nursing home residents. All patients were Veterans, and 97.6% were male, so results may not apply to women or non-Veteran residents. The study used charts only, so families and patients could not provide their perspective. Data were from 2013 and one year, so current practice and trends may differ. VA hospitals have inpatient palliative care teams, so reflexive ICU transfers may differ in other hospitals. The authors describe the work as hypothesis generating.
Declared interests
The authors report no conflicts of interest. Publication types list U.S. government non-PHS and NIH extramural support.
The easy way to misread this
Do not conclude that families usually demanded ICU care. The most common path was family members initially favoring high-intensity treatment and later limiting care (18 of 41), and only four patients had families who repeatedly advocated for high-intensity care.