Intensive Care of Elderly: What do They Wish for Themselves?

Haukeland University Hospital

Status: Active, not recruiting

Conditions: Critical Illness; Aged, 80 and Over

Treatments: Other: survey "Intensive care of very elderly: What do they wish for themselves?"

Study type: Observational

Funder types: Other

Identifiers

NCT05149040

277504

Details and patient eligibility

About

Do very elderly adults wish intensive care in the event of acute life-threatening illness and are their next of kin able to predict these preferences?

Very elderly patients are a steeply increasing patient population in intensive care units (ICUs), but the overall benefit of intensive care for these patients remains controversial. Will ICU admission improve survival and quality of life, or will it prolong suffering and delay natural death? Little is known about very elderly Norwegians life sustaining treatment (LST) preferences in these situations where treatment benefit is uncertain.

This project aims to improve critically ill very elderly patients' ICU trajectories by bringing forth knowledge about their treatment preferences, their family members' ability to predict these preferences, and by directing attention to the challenges of consent to critical care in cases of medical uncertainty.

A selv administered, mailed survey will be distributed among 400 outpatients aged 80 years or older and their next of kin. Respondents will be recruited at the ophthalmologic, ear-nose-and-throat and orthopaedic outpatient clinics at Haukeland University Hospital Bergen, Norway.

The investigators developed and validated a survey tool for this purpose, containing 3 hypothetical scenarios of acute life-threatening illness. The scenarios are randomly chosen from 20 hypothetical patient histories and are representative for ICU admission diagnoses in Norway and Europe. The participants will be asked for treatment choices, i.e. wishing admission to intensive care or not. A response option 'not wishing to engage in the treatment decision' is also provided.

Furthermore, the questionnaire includes factors that may influence elderlies' treatment preferences and proxies' ability to predict these preferences including: demographics, religion, previous experience with and / or communication about critical illness, comorbidity, frailty, quality of life, and projections (i.e. the proxy's own treatment preferences).

The respondents are requested to explain their choices by free-text comments after each scenario. They are also asked to elaborate how they wish next-of-kin should contribute to decision making in these cases. Additional space for free-text comments is provided in the end of the questionnaire.

The study design is exploratory. Responses will be analysed with both quantitative statistics and qualitative methods.

Enrollment: 1,472 patients

Sex: All

Ages: 80+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria: Outpatients aged 80 years or older who register for appointment at the ophthalmologic, ear-nose-and-throat, and orthopaedic outpatient clinic at Haukeland University Hospital, Bergen, Norway.

Exclusion Criteria:

1. not consenting to participate

2. living in permanent care facility / nursing home

3. not able to complete the questionnaire owing to:

   • severely reduced vision / blindness
   • high degree of frailty (Clinical frailty scale ≥ 7)
   • cognitive impairment

Trial design

1,472 participants in 2 patient groups

very elderly outpatients

Description:

outpatients (eyes, ear-nose-and throat, orthopaedic outpatient clinics at Haukeland University Hospital, Bergen, Norway) aged 80 years and older

Treatment:

Other: survey "Intensive care of very elderly: What do they wish for themselves?"

proxy

Description:

next of kin who likely would act as a proxy in a medical emergency, identified by the very elderly respondent

Treatment:

Other: survey "Intensive care of very elderly: What do they wish for themselves?"