Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-22T17:47:55.523Z Has data issue: false hasContentIssue false
  • English
  • Français

Intensive Care for the Elderly

Published online by Cambridge University Press:  10 March 2009

Bryan Jennett
Bryan Jennett
Affiliation:
University of Glasgow
Get access Rights & Permissions [Opens in a new window]

Extract

In 1852 Florence Nightingale wrote, “It is valuable to have one place in the hospital where postoperative and other patients needing close attention can be watched”. Almost 100 years later, an American “anesthesia study commission” concluded that one-third of postoperative deaths in the first 24 hours could have been prevented by better nursing care. Yet it is only in the last 25 years that designated intensive care units have become a feature of acute hospitals in developed countries. In the United States, intensive care beds now comprise 15% of acute beds, and they cost at least two to three times more than ordinary ward beds. Over half the difference between “activity and treatment” in hospitals in the United States and in the United Kingdom is attributed to the much lower provision of intensive care in Britain (1), where such units comprise only 1% of acute hospital beds. Selection for intensive care is therefore more stringent than in the United States, as it is for other high technology procedures (e.g., coronary artery surgery and renal dialysis). However, even in the United States there is now reluctant recognition not only that health care as a whole has to be rationed, but also that unlimited access to high technology medicine is not always in the best interests of patients and their families. In particular the cost-benefit ratio of intensive care for certain types of patients has recently come under scrutiny at an NIH Consensus Development Conference (2) and at the Massachusetts General Hospital (3).

Type
Technology and Health Care for the Elderly
Information
International Journal of Technology Assessment in Health Care , Volume 1 , Issue 1 , January 1985 , pp. 7 - 19
Copyright
Copyright © Cambridge University Press 1985

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Klein, R.Rationing health care. British Medical Journal, 1984, 289, 143–44.CrossRefGoogle ScholarPubMed
2.Office of Medical Applications of Research (NIH). Critical care medicine: Report of a consensus development conference. Journal of the American Medical Association, 1983, 250, 798–804.CrossRefGoogle Scholar
3.Singer, D. E., Carr, P. L., Mulley, A. G. et al. , Rationing intensive care—Physician responses to a resource shortage. New England Journal of Medicine, 1983, 309, 1155–60.CrossRefGoogle ScholarPubMed
4.Knaus, W. A., Draper, E. A., Wagner, D. P. et al. , Evaluating outcome from intensive care: A preliminary multihospital comparison. Critical Care Medicine, 1982, 10, 491–96.CrossRefGoogle ScholarPubMed
5.Knaus, W. A., Wagner, D. P., Loirat, P. et al. , A comparison of intensive care in the USA and France. Lancet, 1982, 2, 642–46.CrossRefGoogle ScholarPubMed
6.Jennett, B., Teasdale, G., Fry, J. et al. , Treatment for severe head injury. Journal Neurology, Neurosurgery, and Psychiatry, 1980, 43, 289–95.CrossRefGoogle ScholarPubMed
7.Bates, D., Caronna, J. J., Cartlidge, N. E. F. et al. , A prospective study of nontrau-matic coma: Methods and results in 310 patients. Annals of Neurology, 1977, 2, 215–20.CrossRefGoogle ScholarPubMed
8.Jennett, B. Outcome of intensive therapy for severe head injuries: An inter-center comparison. In Ayres, S. M. & Parrillo, J. E., Eds., Major issues in critical care medicine. Baltimore: Williams & Wilkins, 1984.Google Scholar
9.Knaus, W. A., Wagner, D. P., Draper, E. A. et al. ,, Eds. The range of intensive care services today. Journal of the American Medical Association, 1981, 246, 2711–16.CrossRefGoogle ScholarPubMed
10.Thibault, G. E., Mulley, A. G., & Barnett, C. O.Medical intensive care: Indications, interventions and outcome. New England Journal of Medicine, 1980, 302, 938–42.CrossRefGoogle Scholar
11.Jennett, B.High technology medicine—Benefits and Burdens. London: Nuffield Provincial Hospital Trust, 1984.Google Scholar
12.Reiss, R.Moral and ethical issues in geriatric surgery. Journal of Medical Ethics, 1980, 6, 7–17.CrossRefGoogle ScholarPubMed
13.Strang, I. W., Boddy, F. A., & Jennett, B.Patients in acute surgical wards: A survey in Glasgow. British Medical Journal, 1977, 1, 545–48.CrossRefGoogle ScholarPubMed
14.Monro, J. L., Ross, J. K., Manners, J. M. et al. , Cardiac surgery in Wessex. British Medical Journal, 1983, 286, 361–65.CrossRefGoogle ScholarPubMed
15.Seymour, D. G., & Pringle, R.A new method of auditing surgical mortality rates: Application to a group of elderly general surgical patients. British Medical Journal, 1982, 284, 1539–42.CrossRefGoogle ScholarPubMed
16.Bedell, S. E., & Delbanco, T. L.Choices about cardiopulmonary resuscitation in the hospital. New England Journal of Medicine, 1984, 310, 1089–93.CrossRefGoogle ScholarPubMed
17.Fusgen, I., & Summa, J.-D.How much sense is there in an attempt to resuscitate an aged person? Gerontology, 1978, 24, 37–45.CrossRefGoogle Scholar
18.Crane, D.Decisions to treat critically ill patients: A comparison of social versus medical considerations. Milbank Memorial Fund Quarterly, 1975, 53, 1–33.CrossRefGoogle ScholarPubMed
19.Gulati, R. S., Bhan, G. L., & Horan, M. A.Cardiopulmonary resuscitation of old people. Lancet, 1983, 2, 267–69.CrossRefGoogle ScholarPubMed
20. Should dying be a diagnosis? Lancet, 1983, 2, 261.CrossRefGoogle Scholar
21.Bird, A. R., & Scargie, R.Cardiopulmonary resuscitation of old people. Lancet, 1982, 2, 514.Google Scholar
22.Marchionni, N., Pini, R., & Vanucci, B. et al. , Acute myocardial infarction in the elderly: A review of 2056 cases. Journal of Clinical and Experimental Gerontology, 1983, 5, 265–83.Google Scholar
23.Marchionni, N., Pini, R., Vanucci, B. et al. , Intensive care for the elderly with acute myocardial infarction. Journal of Clinical and Experimental Gerontology, 1981, 3, 47–62.Google Scholar
24.Williams, B. O., Begg, T. B., Semple, T. et al. , The elderly in a coronary unit. British Medical Journal, 1976, 2, 451–53.CrossRefGoogle Scholar
25.Teasdale, G., Skene, A., Spiegelhalter, D. et al. , Age, severity and outcome of head injury. In Glassman, R. G. & Gildenberg, P. L., Eds. Head injury: Basic and clinical aspects. New York: Raven Press, 1982.Google Scholar
26.Jennett, B., & Teasdale, G.Management of head injury. Philadelphia: F. A. Davis, 1981.Google ScholarPubMed
27.Beauchamp, T. L., & Childress, J. F.Principles of biomedical ethics (2nd ed.) New York: Oxford University Press, 1983.Google Scholar
28.Fries, J. F.Aging, natural death, and the compression of morbidity. New England Journal of Medicine, 1980, 303, 130–35.CrossRefGoogle ScholarPubMed
29.Eisendrath, S. J., & Jonsen, A. R.The living will: Help or hindrance? Journal of the American Medical Association, 1983, 249, 2054–58.CrossRefGoogle ScholarPubMed
30.Barondess, J. A.Prolonging what? Ethical issues in terminal care. Journal of the American Medical Association, 1983, 249, 2073–74.CrossRefGoogle ScholarPubMed
31.Rabkin, M. T., Gillerman, G., & Rice, N. R.Orders not to resuscitate. New England Journal of Medicine, 1976, 295, 364–66.CrossRefGoogle ScholarPubMed
32.Poptopidden, H., Chairman. Optimum care for hopelessly ill patients: A report of the clinical care committee of the Massachusetts General Hospital. New England Journal of Medicine, 1976, 295, 362–64.Google Scholar
33.Lo, p., & Jonsen, A. R.Clinical decisions to limit treatment. Annals of Internal Medicine, 1980, 93, 164–68.CrossRefGoogle ScholarPubMed
34.Lynn, J., & Childress, J. F.Must patients always be given food and water? Hastings Center Report, 1983, 10, 17–21.CrossRefGoogle ScholarPubMed
35.Robertson, G. S.Ethical dilemmas of brain failure in the elderly. British Medical Journal, 1983, 287, 1775–77.CrossRefGoogle ScholarPubMed
36.Norberg, A., Norberg, B., & Bexell, G.Ethical problems in feeding patients with advanced dementia. British Medical Journal, 1980, 281, 847–48.CrossRefGoogle ScholarPubMed
37. 1970. Not strive officiously. Lancet, 1970, 2, 915.Google Scholar
38.Bayliss, R. I. S.Thou shalt not strive officiously. British Medical Journal, 1982, 285, 1373–75.CrossRefGoogle Scholar
39.Curran, W. J.Quality of life and treatment decisions: The Canadian Law Reform Report. New England Journal of Medicine, 1984, 310, 297–98.CrossRefGoogle ScholarPubMed
40.Cohen, Cynthia B.Ethical problems of intensive care. Anesthesiology, 1977, 47, 217–226.CrossRefGoogle ScholarPubMed
41.Bayer, R., Callahan, D., Fletcher, J. et al. , The care of the terminally ill: Morality and economics. New England Journal of Medicine, 1983, 309, 1490–94.CrossRefGoogle ScholarPubMed
42.Jennett, B.The way ahead for acute hospital services: Delay Cure or Deny Rescue. Lancet, 1976, 2, 12135–37.Google ScholarPubMed
43.Jennett, B.Inappropriate use of intensive care. British Medical Journal, 1984, 289, 1709–11.CrossRefGoogle ScholarPubMed