A new study raises red flags about the use of ventilators among dementia patients in intensive care units.
Researchers analyzed data from about 635,000 hospitalizations of U.S. nursing home patients with advanced dementia. Between 2000 and 2013, ventilator use among these patients, whose average age was 84, nearly doubled at the 2,600 hospitals studied. But more than 80 percent of the patients died within a year, the study found.
"These findings call for new efforts to ensure that the use of mechanical ventilation is consistent with patient's goals of care and their clinical condition," said corresponding author Dr. Joan Teno. She is a professor of medicine, gerontology and geriatrics and a palliative care specialist at the University of Washington in Seattle.
"We want to raise a fundamental policy question of how to improve end-of-life care, and particularly for very vulnerable populations. We want caregivers to think and talk about whether this type of care is achieving the patient's goals and value for society," she explained in a university news release.
Nursing homes should do more to educate families about their loved one's prognosis and the risks and benefits of hospitalization, she said. In addition, hospitals need to ensure that decisions about life-sustaining treatments reflect patients' wishes, Teno added.
Study co-author Dr. Vincent Mor pointed out that "while it is rarely known in advance that a treatment like mechanical ventilation in the ICU is futile for a given patient, it would be sad to think that a vulnerable patient was admitted to an ICU merely to fill a recently built empty bed, which our data suggests may be happening." Mor is a professor of health services, policy and practice at Brown University School of Public Health in Providence, R.I.topics from