High burden of palliative needs among older intensive care unit survivors transferred to post-Acute care facilities

Matthew R. Baldwin*, Hannah Wunsch, Paul Andrew Reyfman, Wazim R. Narain, Craig D. Blinderman, Neil W. Schluger, M. Cary Reid, Mathew S. Maurer, Nathan Goldstein, David J. Lederer, Peter Bach

*Corresponding author for this work

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Rationale: Adults with chronic critical illness (tracheostomy after>10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-Acute care facilities. Objectives: To determine whether older ICU survivors discharged to post-Acute care facilities have potentially unmet palliative care needs. Methods: We examined electronic records from a 1-year cohort of 228 consecutive adults>65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-Acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. Measurements and Main Results: The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%. Conclusions: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.

Original languageEnglish (US)
Pages (from-to)458-465
Number of pages8
JournalAnnals of the American Thoracic Society
Volume10
Issue number5
DOIs
StatePublished - Oct 1 2013

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Subacute Care
Palliative Care
Intensive Care Units
Survivors
Artificial Respiration
Mortality
Referral and Consultation
Hospices
Tracheostomy
Tertiary Care Centers
Critical Illness
Hospitalization
Chronic Disease

Keywords

  • Aged
  • Critically ill
  • Nursing homes
  • Palliative medicine

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Baldwin, Matthew R. ; Wunsch, Hannah ; Reyfman, Paul Andrew ; Narain, Wazim R. ; Blinderman, Craig D. ; Schluger, Neil W. ; Reid, M. Cary ; Maurer, Mathew S. ; Goldstein, Nathan ; Lederer, David J. ; Bach, Peter. / High burden of palliative needs among older intensive care unit survivors transferred to post-Acute care facilities. In: Annals of the American Thoracic Society. 2013 ; Vol. 10, No. 5. pp. 458-465.
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title = "High burden of palliative needs among older intensive care unit survivors transferred to post-Acute care facilities",
abstract = "Rationale: Adults with chronic critical illness (tracheostomy after>10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-Acute care facilities. Objectives: To determine whether older ICU survivors discharged to post-Acute care facilities have potentially unmet palliative care needs. Methods: We examined electronic records from a 1-year cohort of 228 consecutive adults>65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-Acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. Measurements and Main Results: The median age was 78 years (interquartile range, 71-84 yr), and 54{\%} received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6{\%}) received a palliative care consultation during the hospitalization. However, 88{\%} had at least one potential palliative care need; 22{\%} had chronic wounds, 37{\%} were discharged on supplemental oxygen, 17{\%} received chaplaincy services, 23{\%} preferred to not be resuscitated, and 8{\%} were designated {"}comfort care.{"} The 6-month mortality was 40{\%}. Conclusions: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.",
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author = "Baldwin, {Matthew R.} and Hannah Wunsch and Reyfman, {Paul Andrew} and Narain, {Wazim R.} and Blinderman, {Craig D.} and Schluger, {Neil W.} and Reid, {M. Cary} and Maurer, {Mathew S.} and Nathan Goldstein and Lederer, {David J.} and Peter Bach",
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Baldwin, MR, Wunsch, H, Reyfman, PA, Narain, WR, Blinderman, CD, Schluger, NW, Reid, MC, Maurer, MS, Goldstein, N, Lederer, DJ & Bach, P 2013, 'High burden of palliative needs among older intensive care unit survivors transferred to post-Acute care facilities', Annals of the American Thoracic Society, vol. 10, no. 5, pp. 458-465. https://doi.org/10.1513/AnnalsATS.201303-039OC

High burden of palliative needs among older intensive care unit survivors transferred to post-Acute care facilities. / Baldwin, Matthew R.; Wunsch, Hannah; Reyfman, Paul Andrew; Narain, Wazim R.; Blinderman, Craig D.; Schluger, Neil W.; Reid, M. Cary; Maurer, Mathew S.; Goldstein, Nathan; Lederer, David J.; Bach, Peter.

In: Annals of the American Thoracic Society, Vol. 10, No. 5, 01.10.2013, p. 458-465.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High burden of palliative needs among older intensive care unit survivors transferred to post-Acute care facilities

AU - Baldwin, Matthew R.

AU - Wunsch, Hannah

AU - Reyfman, Paul Andrew

AU - Narain, Wazim R.

AU - Blinderman, Craig D.

AU - Schluger, Neil W.

AU - Reid, M. Cary

AU - Maurer, Mathew S.

AU - Goldstein, Nathan

AU - Lederer, David J.

AU - Bach, Peter

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Rationale: Adults with chronic critical illness (tracheostomy after>10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-Acute care facilities. Objectives: To determine whether older ICU survivors discharged to post-Acute care facilities have potentially unmet palliative care needs. Methods: We examined electronic records from a 1-year cohort of 228 consecutive adults>65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-Acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. Measurements and Main Results: The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%. Conclusions: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.

AB - Rationale: Adults with chronic critical illness (tracheostomy after>10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-Acute care facilities. Objectives: To determine whether older ICU survivors discharged to post-Acute care facilities have potentially unmet palliative care needs. Methods: We examined electronic records from a 1-year cohort of 228 consecutive adults>65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-Acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. Measurements and Main Results: The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%. Conclusions: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.

KW - Aged

KW - Critically ill

KW - Nursing homes

KW - Palliative medicine

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