Bioethics Blogs

Too Many Elderly Patients in U.S. ICUs

Paul Marik at Eastern Virginia Medical School argues that we provide too much extraordinary invasive life-sustaining measures to critically ill octogenarians.  (American Journal of Hospice & Palliative Medicine, Nov. 2015)

He contrasts this situation with that in Europe where a majority are refused admission to the ICU because they are considered too sick or too well.  

Here is the abstract:

“Elderly patients patients (older than 65 years) account for only 11% of the US population yet they account for 34% of health care expenditure. The disproportionate usage of health care costs by elderly patients is in striking contrast with that of other Western Nations. It is likely that these differences are largely due to variances in hospitalization and the use of high technology health care resources at the end of life. The United States has 8 times as many intensive care unit (ICU) beds per capita when compared to other Western Nations. In the United States, elderly patients currently account for 42% to 52% of ICU admissions and for almost 60% of all ICU days. A disproportionate number of these ICU days are spent by elderly patients before their death. In many instances, aggressive life supportive measures serve only to prolong the patient’s death. Such treatment inflicts pain and suffering on the patient (with little prospects of gain) and incurs enormous financial costs to the health care system. We present the case of an 86-year-old female who spent almost 3 months in our ICU prior to her death. The fully allocated hospital costs for this patient were estimated to be US$254 945 (US$5100/d).

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