Dementia: Use of Mechanical Ventilation Increasing Rapidly

Tara Lagu MD PhD Assistant Professor of Medicine Tufts University School of Interview with:
Tara Lagu MD PhD
Assistant Professor of Medicine
Tufts University School of Medicine What are the main findings of the study?

Dr. Lagu: We found that use of mechanical ventilation in patients 65 and older is increasing rapidly. If current rates of increase continue, we expect that by 2020 there will be more than 600,000 hospitalizations per year that involve mechanical ventilation. This is a doubling in 20 years (2001-2020), and represents demand that could easily exceed the capacity of the US critical care system. We also found that increase in use among patients with dementia is 4 times faster than those without dementia. This is important because dementia is a terminal illness, and use of mechanical ventilation in patients with end-stage dementia is associated with poor 30-day and 1-year outcomes. Were any of the findings unexpected?

Dr. Lagu: There has been a trend in the last few years towards increasing use of intensive care services for elderly patients. Because of this and because our population is aging, we suspected that there would be an increase in demand for mechanical ventilation in patients 65 and older. I think we were somewhat surprised at the very large expected numbers for the next five years-  the critical care system is already quite strained and this increase in demand represents a potential crisis unless the system is expanded or changes are made to temper current trends. What should clinicians and patients take away from your report?

Dr. Lagu: As demand for critical care increases, we will need to determine how to best allocate these resources. One way to do this is to only use intensive care therapies, such as mechanical ventilation, in patients who wish to receive them. This means that clinicians must discuss, with patients and families, preferences about desired treatments before the patient is critically ill. These conversations may be most important in patients who have end-stage terminal illnesses and are least likely to benefit from intensive care. What recommendations do you have for future research as a result of this study?

Dr. Lagu: We are very interested to know how patients with and without dementia fare after receiving mechanical ventilation, so we are currently working to understand short-term outcomes in this population. We are also interested in better understanding the barriers to having conversations about treatment preferences. For example, it may be difficult for patients and families to understand why doctors want to ask these questions at a time when the patient is not ill. In contrast, doctors know that asking about treatment preferences earlier prevents having to ask during a time of crisis, but may worry that it is confusing and scary to the patient to bring up these questions “out of blue” during a routine follow up or annual physical.



Use of Mechanical Ventilation by Patients With and Without Dementia, 2001 Through 2011

Tara Lagu, MD, MPH; Marya D. Zilberberg, MD, MPH; Jennifer Tjia, MD, MSCE; Penelope S. Pekow, PhD; Peter K. Lindenauer, MD, MSc



Last Updated on April 28, 2014 by Marie Benz MD FAAD