Can the Wish to Receive Intensive Treatment in Elderly Patients with Respiratory Tract Infection Be Predicted?

• Published in: Internal Medicine Vol. 57; no. 14; pp. 1989 - 1993
• Main Authors: Hagiwara, Shuichi, Kaneko, Minoru, Aoki, Makoto, Murata, Masato, Ichikawa, Yumi, Nakajima, Jun, Isshiki, Yuta, Sawada, Yusuke, Tamura, Jun'ichi, Oshima, Kiyohiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.07.2018; Japan Science and Technology Agency
• Subjects: Advance Directives - psychology; Aged; Aged, 80 and over; Asian Continental Ancestry Group - psychology; Coma; Critical Care - psychology; Dementia disorders; elderly; Female; Forecasting; Geriatrics; Humans; Infections; Internal medicine; Japan; living will; Male; Odds Ratio; Older people; Original; Patient Preference - psychology; Patients; Regression analysis; Respiratory tract; Respiratory tract diseases; Respiratory tract infection; Respiratory Tract Infections - therapy; Retrospective Studies; respiratory tract infection; living will; elderly
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.0155-17

Objective Almost no Japanese elderly patients have an advance directive (AD). Our aim was to determine whether or not the wish to receive intensive care in elderly patients with respiratory tract infection could be predicted from the prehospital data. Methods In this retrospective study, we reviewed patients ≥65 years of age with respiratory tract infection who had been transferred to our hospital by ambulance between September 2014 and August 2016. The patients were divided into two groups according to whether or not they wished to receive intensive treatment. We placed patients without a wish to receive intensive treatments (WITs) in Group A and patients with a WITs in Group B. We then analyzed parameters that could be determined in the prehospital phase and compared the findings between the groups. Results Thirty-seven patients were in Group A, and 67 patients were in Group B. None of the patients in this study had an AD. There were significant differences in the age, rate of residence in an extended care facility, frequency of inability to care for oneself fully, frequency of dementia, number of prescribed drugs, and Glasgow coma scale (GCS) on a univariate analysis. A logistic regression analysis showed that the inability to care for oneself fully [odds ratio (OR): 4.521, 95% confidence interval (CI): 2.024-10.096, p<0.001] and a low GCS (OR 0.885, 95%CI 0.838-0.935, p<0.001) were related to a WITs. Conclusion Elderly patients who are unable to care for themselves and who have a low GCS in the prehospital stage are likely not to want intensive treatment.