In this issue, Campion and associates (p 2052) present interesting and important data in regard to medical intensive care for the elderly. Results in several instances are the opposite of what one might expect, for example, that elderly patients had no longer mean length of stay and no greater mean hospital charges than younger patients, and that despite the high mortality for this group, most elderly hospital survivors returned home. The authors are astute in considering selective factors that might explain the various results of this communication. For example, they suggest that more resources might be expended in the effort to prevent inexorable decline to death in the middle-aged patient than in the older patient.
There are gatekeeper-type decisions and decisions to treat or not to treat that may explain the results of this study. These forces are at play not only in critical care units, but also in general
Reichel W. The Continuity Imperative. JAMA. 1981;246(18):2065. doi:10.1001/jama.1981.03320180057034