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October 17, 2017

Admitting Elderly Patients to the Intensive Care Unit—Is it the Right Decision?

Author Affiliations
  • 1University of Pittsburgh School of Medicine, Department of Critical Care Medicine, Pittsburgh, Pennsylvania
  • 2Associate Editor, JAMA, Chicago, Illinois.
JAMA. 2017;318(15):1443-1444. doi:10.1001/jama.2017.14535

One of the most important decisions that a physician makes is whether to admit a patient to the intensive care unit (ICU). The modern ICU provides a capacity for advanced monitoring and life support that is typically unavailable elsewhere in the hospital and is lifesaving for patients with a wide array of acute deteriorations in health. However, ICU care is also one of the most expensive, intensive, and intrusive endeavors in health care. Although patients admitted to the ICU account for approximately one-quarter of hospitalized patients, they account for half of total hospital expenditures in the United States, with costs estimated at $110 to $260 billion per year or approximately 1% of the gross domestic product.1-3 Furthermore, ICU care can be unnecessary, harmful, or futile. Importantly, the provision of ICU services is increasing. In an era when efforts to contain health care costs have decreased total hospital beds, the number of ICU beds continues to increase.4 An important question is whether this growth in ICU services and beds is necessary to meet the demands of an expanding population of critically ill patients or whether ICU beds are being oversupplied and subsequently are being filled with patients who might be cared for in less-intense settings at lower cost with similar or better outcome.