Foley Chloe, Bloomer Melissa, Hutchinson Alison M
Latrobe Regional Hospital, 10 Village Avenue, Traralgon, VIC, 3844, Australia; School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
Aust Crit Care. 2023 Mar;36(2):274-284. doi: 10.1016/j.aucc.2021.12.006. Epub 2022 Feb 7.
The population worldwide is rapidly ageing, and demand for intensive care is increasing. People aged 85 years and above, known as the oldest old, are particularly vulnerable to critical illness owing to the physiological effects of ageing. Evidence surrounding admission of the oldest old to the intensive care is limited.
The objective of this study was to systematically and comprehensively review and synthesise the published research investigating factors that influence decisions to admit the oldest old to the intensive care unit.
This was a systematic review and narrative synthesis. Following a comprehensive search of CINAHL, Embase, and Medline databases, peer-reviewed primary research articles examining factors associated with admission or refusal to admit the oldest old to intensive care were selected. Data were extracted into tables and narratively synthesised.
Six studies met the inclusion criteria. Three studies identified factors associated with admission such as greater premorbid self-sufficiency, patient preferences, alignment between patient and physicians' goals of treatment, age less than 85 years, and absence of cancer, or previous intensive care admission. Factors associated with refusal to admit were identified in all six studies and included limited or no bed availability, level of ICU physician experience, patients being deemed too ill or too well to benefit, and older age.
Published research investigating decision-making about admission or refusal to admit the oldest old to the intensive care unit is scant. The ageing population and increasing demand for intensive care unit resources has amplified the need for greater understanding of factors that influence decisions to admit or refuse admission of the oldest old to the intensive care unit. Such knowledge may inform guidelines regarding complex practice decisions about admission of the oldest old to an intensive care unit. Such guidelines would ensure the specialty needs of this population are considered and would reduce admission decisions that might disadvantage older people.
全球人口正在迅速老龄化，对重症监护的需求也在增加。85岁及以上的人群，即所谓的高龄老人，由于衰老的生理影响，特别容易患重病。关于高龄老人入住重症监护病房的证据有限。
本研究的目的是系统、全面地回顾和综合已发表的研究，调查影响高龄老人入住重症监护病房决策的因素。
这是一项系统综述和叙述性综合分析。在全面检索CINAHL、Embase和Medline数据库后，选择了经同行评审的关于与高龄老人入住或拒绝入住重症监护相关因素的原发性研究文章。数据被提取到表格中并进行叙述性综合分析。
六项研究符合纳入标准。三项研究确定了与入住相关的因素，如病前自理能力较强、患者偏好、患者与医生治疗目标一致、年龄小于85岁、无癌症或既往未入住过重症监护病房。所有六项研究都确定了与拒绝入住相关的因素，包括床位有限或无床位、重症监护室医生的经验水平、患者被认为病情过重或过轻而无法受益以及年龄较大。
关于高龄老人入住或拒绝入住重症监护病房决策的已发表研究很少。人口老龄化和对重症监护病房资源需求的增加，加大了对影响高龄老人入住或拒绝入住重症监护病房决策因素的深入理解的需求。这些知识可能为有关高龄老人入住重症监护病房复杂实践决策的指南提供参考。这样的指南将确保考虑到这一人群的特殊需求，并减少可能对老年人不利的入住决策。
