Intensive care utilization among nursing home residents with advanced cognitive and severe functional impairment

Ana Tuya Fulton, Pedro Gozalo, Susan L. Mitchell, Vince Mor, Joan Teno

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Dementia is a progressive terminal illness which requires decisions around aggressiveness of care. Objective: The study objective was to examine the rate of intensive care unit (ICU) utilization and its regional variation among persons with both advanced cognitive and severe functional impairment. Methods: We utilized the Minimum Data Set (MDS) to identify a cohort of decedents between 2000 and 2007 who (1) were in a nursing home (NH) 120 days prior to death and (2) had an MDS assessment indicating advanced cognitive and functional impairment as identified by cognitive performance scale (CPS) ≥5 and total dependence or extensive assistance in seven activities of daily living (ADLs). ICU utilization in the last 30 days of life was determined from Medicare claims files. A multivariate logistic regression model examined the likelihood of ICU admission in 2007 versus 2000 adjusting for sociodemographics, orders to limit life sustaining treatment, and health status. Results: Among 474,829 Medicare NH residents with advanced cognitive impairment followed during 2000-2007, we observed an increase in ICU utilization from 6.1% in 2000 to 9.5% in 2007. After adjustment for sociodemographic characteristics, orders to limit life sustaining treatment, and measures of health status, the likelihood of a resident being admitted to an ICU was higher in 2007 compared to 2000 (adjusted odds ratio [OR] 1.71, 95% CI 1.60-1.81). Additionally, substantial regional variation was noted in ICU utilization, from 0.82% in Montana to 22% in the District of Columbia. Conclusions: Even among patients with advanced cognitive and functional impairment, ICU utilization in the last 30 days increased and varied by geographic region.

Original languageEnglish (US)
Pages (from-to)313-317
Number of pages5
JournalJournal of palliative medicine
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

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Critical Care
Nursing Homes
Intensive Care Units
Medicare
Health Status
Logistic Models
Activities of Daily Living
Dementia
Odds Ratio
Therapeutics
Cognitive Dysfunction

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine
  • Nursing(all)

Cite this

Intensive care utilization among nursing home residents with advanced cognitive and severe functional impairment. / Fulton, Ana Tuya; Gozalo, Pedro; Mitchell, Susan L.; Mor, Vince; Teno, Joan.

In: Journal of palliative medicine, Vol. 17, No. 3, 01.03.2014, p. 313-317.

Research output: Contribution to journalArticle

Fulton, Ana Tuya ; Gozalo, Pedro ; Mitchell, Susan L. ; Mor, Vince ; Teno, Joan. / Intensive care utilization among nursing home residents with advanced cognitive and severe functional impairment. In: Journal of palliative medicine. 2014 ; Vol. 17, No. 3. pp. 313-317.
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