Of older adults who undergo intubation in the emergency department, 33% die during the index hospitalization, according to a study published recently in the Journal of the American Geriatrics Society.
Emergency intubation of older adults is becoming more frequent and is expected to double between 2001, and 2020.2,3 Older adults who are intubated may not survive, and when surviving, may have the very poor quality of life.
More than 70% of older adults with serious illness prioritize quality of life and quality of dying over longevity and consider some health states worse than death, yet 56% to 99% of older adults do not have advance directives available at the time of emergency department (ED) presentation.
Kei Ouchi, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues conducted a retrospective cohort study involving adults aged 65 years and older intubated in the emergency department during 2008 to 2015 at 262 U.S. hospitals.
A total of 41,463 emergency department intubation encounters were identified; 35,036 were included in the final analysis. The researchers found that in-hospital mortality was 33% overall.
Twenty-four and 41% of subjects were discharged to home and a location other than home, respectively. Mortality varied with age and was 29, 34, 40, 43, and 50% for those aged 65 to 74, 75 to 79, 80 to 84, 85 to 89, and 90 years and older, respectively.
The primary outcome was age?specific in?hospital mortality. Secondary outcomes were age?specific odds of death after adjusting for race, comorbid conditions, admission diagnosis, hospital disposition, and geographic region.
"During shared decision-making, individuals aged 65 and older and their surrogates can be informed that, after intubation, the overall chance of survival and discharge to home after the index hospitalization is 24%," the authors write. "There is a 33% chance of in-hospital death and a 67% chance of survival to hospital discharge."
After emergency intubation, 33% percent of older adults die during the index hospitalization. Only 24% of survivors are discharged to home. Simple, graphic representations of this information, in combination with an experienced clinician's overall clinical assessment, will support shared decision?making regarding unplanned intubation.
Clinicians in the fields of primary care, oncology, palliative care, and emergency medicine may find themselves discussing goals of care with patients and their caregivers; whether to undergo intubation should it become indicated is an important consideration.
During shared decisionmaking, individuals aged 65 and older and their surrogates can be informed that, after intubation, the overall chance of survival and discharge to home after the index hospitalization is 24%.