End-of-Life Care for Older Adults in ICUs

Abstract

This review was undertaken to present and critique the most recent (1990-2000) empirical evidence about end-of-life care for older adult patients in ICUs, their families, and care providers. The studies (including descriptive, correlational, longitudinal, and intervention) were found using a combination of these terms: (a) intensive care (units) or critical care (units), and (b) critical illness, critically ill patients, terminally ill, terminal care, life support care, or palliative care. The computerized databases searched were CINAHL and MEDLINE. Only published studies of persons 44 years of age or older, written in English, and conducted in the U.S. or Canada were included. Research was not limited to studies conducted by or written by nurses. Excluded were articles focused on physiology, for example, studies of treatment for specific conditions, and articles focused on predictors of ICU outcomes.Findings and Implications for ResearchThere is little research specifically focused on end-of-life care of older adults in ICUs. Most research has been retrospective, and most has involved either providers or patients and families but not both.Research is needed in many areas. The mechanism by which age affects choice of care needs further exploration. The experience of patients, families, and providers and how those experiences change with interventions needs investigation. The influence of the ICU culture, variation in decisions made and reasons for that variation, the decision-making process, and variations in care, all require further attention. Four domains were identified for research needed to improve care for older adults at the end of life in intensive care: symptom relief, communication improvement, psychological support, and relationship improvement. No one has assessed whether the ICU is a good place for transition to palliation to occur, or whether it would be better to transfer patients to another type of unit.