TREATMENT-LIMITING DECISIONS, COMORBIDITIES, AND MORTALITY IN THE EMERGENCY DEPARTMENTS: A CROSS-SECTIONAL ELDERLY POPULATION-BASED STUDY

Older adults experience a higher risk of death in the emergency departments (eds), in part, as a result of their comorbidities. a treatment-limiting decision is often reported for older adults who die in the eds. the charlson comorbidity index (cci) is a validated method for the scoring of comorbidities. whether an association between the cci and treatment-limiting decisions exists remains unknown. Objective: to determine whether the cci was associated with the treatment-limiting decisions made for older patients who die in the eds. Methods: a total of 2,095 patients ≥65 years old who died in the eds in France and Belgium were prospectively included between 2004 and 2005. the recorded data included: 1) the cci score; 2) patient age; 3) gender; 4) living in senior housing facilities; 5) hospitalizations occurring in the previous year; 6) presence of functional limitations (according to the knaus classification); 7) chronic diseases; and 8) presence of organ failure(s). a treatment-limiting decision was defined as a predetermined choice not to implement therapies that would otherwise be required to sustain life. Results: a treatment-limiting decision was identified in 993 (47%) patients. Fully-adjusted logistic regression model showed that a cci ≥ 5 (Or=25.56 with P=0.037), age ≥85years (Or=20.33 with P<0.001), living in an institution (Or=0.15 with P=0.017), hematologic (Or=6.92 with P=0.020) and respiratory disease (Or=0.17 with P=0.046), and neurologic causes (Or=0.20 with P=0.010) of organ failure were significantly associated with treatment-limiting decisions. Conclusion: an elevated cci score (≥5) was associated with a treatment-limiting decision in elderly patients evaluated in the eds. Further research is needed to corroborate this finding