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Mechanical Ventilation in a Cohort of Elderly Patients Admitted to an Intensive Care Unit

E. Wesley Ely, MD, MPH; Gregory W. Evans, MA; and Edward F. Haponik, MD
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From Vanderbilt University Medical Center, Nashville, Tennessee; and Wake Forest University, Winston-Salem, North Carolina.


Note: These data were originally presented at the Pulmonary and Critical Care Geriatric Educational Retreat, 14-18 March 1998, in St. John, U.S. Virgin Islands, and at the Annual Meeting of the American Thoracic Society in San Diego, California, 24-28 April 1999.

Acknowledgments: The authors thank Dr. William Hazzard and the Hartford Foundation for their foresight in considering pulmonary and critical care problems in the elderly as a worthwhile area of future research interest.

Requests for Reprints: E. Wesley Ely, MD, MPH, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, 913 Oxford House, Nashville, TN 37232-4760.

Current Author Addresses: Dr. Ely: Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, 913 Oxford House, Nashville, TN 37232-4760.

Mr. Evans: Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157.

Dr. Haponik: Section of Pulmonary and Critical Care Medicine, The Johns Hopkins Medical Center, 600 North Wolfe Street, Baltimore, MD 21205.


Ann Intern Med. 1999;131(2):96-104. doi:10.7326/0003-4819-131-2-199907200-00004
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The number of adults 85 years of age or older, estimated at approximately 4 million, is expected to double by the year 2030 (1). Health care expenditures in the United States for persons older than 65 years of age are currently $1740 billion (38% of total expenditures). By 2030, this amount is estimated to be $15 970 billion (74% of total expenditures). One approach to reducing health care costs could be to limit or ration the intensive care provided to elderly persons in order to conserve resources (25). Recent data have shown that elderly persons receive less aggressive management for some medical illnesses (6). Data from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) investigators (78) have shown that age (especially >70 to 75 years) greatly affects the intensity of care given to patients and that both physician and patient preferences for cardiopulmonary resuscitation influence consumption of hospital resources (9). Surprisingly few expert consensus reports discuss the decision to treat elderly patients with mechanical ventilation. One publication from the Office of Technology Assessment (10) discussed reasonable perspectives, but few data were presented and opinions were divided as to whether age should be a major determinant in the decision to use mechanical ventilation.

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Figure 1.
Kaplan-Meier analysis of days on mechanical ventilation compared with rate of recovery from respiratory failure.P

The solid line indicates patients 75 years of age or older; the dashed line indicates patients younger than 75 years of age. Cox proportional-hazards analysis adjusting for possible confounders confirmed that patients 75 years of age or older recovered from respiratory failure somewhat more rapidly than did younger patients (risk ratio, 1.58 [CI, 1.3 to 2.22]; = 0.03).

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Figure 2.
Kaplan-Meier analysis showing the survival time of patients on a log scale.P

The solid line indicates patients 75 years of age or older; the dashed line indicates patients younger than 75 years of age. Cox proportional-hazards analysis confirmed that survival did not differ between groups ( > 0.2).

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