Journal of the American Geriatrics Society
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Comparative Study
The impact of age on utilization of intensive care resources.
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. Four age groups were compared: under 55, 55 to 64, 65 to 74, and 75 years of age and over. Severity of illness and prior health were assessed using the Acute Physiology Score (APS) and the Chronic Health Evaluation (CHE) instruments. ⋯ Still, elderly DNR patients received as much resources as younger DNR patients and this was more than non-DNR patients. The sample of patients treated on conventional medical divisions had age distribution similar to the MICU sample. There was some evidence that admission APS (median, 5, 5, 6, 6, respectively, P = .055) and maximum APS (median, 5, 5, 7, 8, respectively, P = .023) differed slightly across age groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Although 10% to 15% of patients admitted to acute care hospitals are in a state of delirium, few patients are given this diagnosis by their clinician. We field-tested the Diagnostic and Statistical Manual III (DSM-III) criteria for diagnosing delirium on 133 consecutively admitted patients to an acute medical ward. Twenty patients were delirious using DSM-III criteria, 19 more patients than were reported by the primary clinician. ⋯ Sixty-five percent of patients with delirium died, whereas significantly fewer (3.3%) of patients without delirium died (P less than .0001). We found that delirium could be readily and reliably detected (kappa coefficient of agreement = 0.62 for interrater reliability) using the DSM-III criteria. Clinicians should routinely screen hospitalized patients of all ages using DSM-III criteria to identify delirious patients for an immediate evaluation and treatment.