Abstract
Objectives
Level of medical intervention (LMI) has to be adapted to each patient in geriatric
care. LMI scales intend to help nonintensive care (NIC) decisions, giving priority
to patient choice and collegial discussion. In the present study, we aimed to assess
the parameters associated with the NIC decision and whether these parameters differ
from those associated with in-hospital mortality.
Design
Prospective observational study.
Setting and Participants
All consecutive patients from a French 62-bed acute geriatric unit over 1 year.
Methods
Factors from the geriatric assessment associated with the decision of NIC were compared
with those associated with in-hospital and 1-year mortality, in univariate and multivariate
analyses.
Results
In total, 1654 consecutive patients (median age 87 years) were included. Collegial
reflection led to NIC decision for 532 patients (32%). In-hospital and 1-year mortality
were 22% and 54% in the NIC group vs 2% and 27% in the rest of the cohort (P < .001 for both). In multivariable analysis, high Charlson Comorbidity Index [odds
ratio (OR) 1.15, 95% confidence interval (CI) 1.06-1.23, per point], severe neurocognitive
disorders (OR 2.78, 95% CI 1.67-4.55), dependence (OR 1.92, 95% CI 1.45-2.59), and
nursing home residence (OR 2.38, 95% CI 1.85-3.13) were highly associated with NIC
decision but not with in-hospital mortality. Conversely, acute diseases had little
impact on LMI despite their high short-term prognostic burden.
Conclusions and Implications
Neurocognitive disorders and dependence were strongly associated with NIC decision,
even though they were not significantly associated with in-hospital mortality. The
decision-making process of LMI therefore seems to go beyond the notion of short-term
survival.
Keywords
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Article info
Publication history
Published online: May 13, 2021
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
