Is coronary-care-unit admission restricted for elderly patients? A multicenter study.
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TLDR
The findings suggest that physicians may intentionally restrict access to coronary care for elderly patients with acute myocardial infarction.Abstract:
BACKGROUND. To investigate whether elderly patients are more likely to experience restricted access to high technology medical care, we examined the impact of age on the likelihood of coronary care unit (CCU) admission for patients with acute myocardial infarction. METHODS. As part of a prospective investigation of emergency room triage for patients with suspected cardiac ischemia, we studied 4223 patients presenting to six hospitals. Because CCU admission is the accepted standard of care for acute infarction, we defined nonadmission to the CCU as a restriction of access to care. We used a logistic regression model to control for gender, hospital, and CCU occupancy at the time of admission and examined the relationship between age and CCU nonadmission. RESULTS. Patients 75 years or older with acute myocardial infarction were 2.5 times more likely not to be admitted to the CCU than younger patients (RR 2.5, 95% CI 1.64, 3.85). Coronary unit admission was restricted even when the physician's admitting diagn...read more
Citations
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Patient Age and Decisions To Withhold Life-Sustaining Treatments from Seriously Ill, Hospitalized Adults
Mary Beth Hamel,Joan M. Teno,Lee Goldman,Joanne Lynn,Roger B. Davis,Anthony N. Galanos,Norman A. Desbiens,Alfred F. Connors,Neil S. Wenger,Russell S. Phillips +9 more
TL;DR: This study studied 9105 seriously ill patients to evaluate how patient age, independent of patients' objective prognoses and preferences for life-extending care, influences physicians' decisions to withhold life-sustaining therapies.
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Characteristics and mortality outcomes of thrombolysis trial participants and nonparticipants: a population-based comparison.
TL;DR: Compared with nontrial patients, thrombolysis trial participants are younger, more often male, undergo more revascularization and have less comorbid disease; even after adjustment for these factors, participants have a survival advantage over nonparticipants that is larger than expected from thrombectomy alone.
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Older Age, Aggressiveness of Care, and Survival for Seriously Ill, Hospitalized Adults
Mary Beth Hamel,Roger B. Davis,Joan M. Teno,William A. Knaus,Joanne Lynn,Frank E. Harrell,Anthony N. Galanos,Albert W. Wu,Russell S. Phillips +8 more
TL;DR: It is hypothesized that less aggressive treatment of seriously ill elderly patients may contribute to higher mortality and that adjustment for treatment intensity and decisions about withholding life-sustaining treatments would diminish and potentially eliminate the short-term survival disadvantage associated with older age.
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Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: Lessons from support
Mary Beth Hamel,Joanne Lynn,Joan M. Teno,Kenneth E. Covinsky,Albert W. Wu,Anthony N. Galanos,Norman A. Desbiens,Russell S. Phillips +7 more
TL;DR: Findings about how patient age influenced patterns of care for seriously ill patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) are reviewed.
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Seriously Ill Hospitalized Adults: Do We Spend Less on Older Patients?
Mary Beth Hamel,Russell S. Phillips,Joan M. Teno,Joanne Lynn,Anthony N. Galanos,Roger B. Davis,Alfred F. Connors,Robert K. Oye,Norman A. Desbiens,Douglas J. Reding,Lee Goldman +10 more
TL;DR: To determine the effect of age on hospital resource use for seriously ill adults, and to explore whether age‐related differences in resource use are explained by patients' severity of illness and preferences for life‐extending care, a large number of patients aged between 18 and 74 are surveyed.
References
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Aging, Natural Death, and the Compression of Morbidity: Another View
TL;DR: The evidence that is reviewed supports quite different conclusions: that the number of very old people is increasing rapidly, that the needs for medical care in later life would decrease, and so on.
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The Impact of Age on Utilization of Intensive Care Resources
Donna K. McClish,Stephen H. Powell,Stephen H. Powell,Hugo D. Montenegro,Hugo D. Montenegro,Michael L. Nochomovitz,Michael L. Nochomovitz +6 more
TL;DR: The impact of age on admission practices and pattern of care were examined in 599 admissions to a medical intensive care unit (MICU) and 290 patients on the conventional medical care divisions of the same hospital.
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Medical Care at the End of Life: The Interaction of Economics and Ethics
TL;DR: The rising cost of medical care in the United States over the past quarter century has become a matter of growing concern for both private citizens and governments at all levels, and the high medical expenses of the elderly has been receiving special attention in recent years.