Neurocognitive Disorders, Dependence Associated With Geriatric Nonintensive Care Decisions

Neurocognitive disorders and dependence are factors strongly associated with geriatric nonintensive care decisions but not significantly associated with in-hospital mortality, according to a new study published in the Journal of the American Medical Directors Association.

Researchers studied 1654 consecutive patients from a 62-bed French acute geriatric unit to compare level of medical intervention scale parameters associated with nonintensive care decisions, in-hospital mortality, and 1-year mortality.

NIC decision was made for 532 patients (32%). In-hospital and 1-year mortality among nonintensive care patients were 22% and 54% compared to 2% and 27%, respectively, for the rest of the patient cohort.

“In multivariable analysis, high Charlson Comorbidity Index [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.06-1.23, per point], severe neurocognitive disorders (OR 2.78, 95% CI 1.67-4.55), dependence (OR 1.92, 95% CI 1.45-2.59), and nursing home residence (OR 2.38, 95% CI 1.85-3.13) were highly associated with nonintensive care decision but not with in-hospital mortality,” explained the researchers.

Level of medical intervention was not greatly impacted by acute diseases despite their high prognostic burden, note the researchers.

“Neurocognitive disorders and dependence were strongly associated with NIC decision, even though they were not significantly associated with in-hospital mortality,” concluded researchers. “The decision-making process of LMI therefore seems to go beyond the notion of short-term survival.”

Reference:
Putot S, Jouanny P, Barben J, et al. Level of medical intervention in geriatric settings: Decision factors and correlation with mortality [published online ahead of print May 13, 2021]. J Am Med Dir Assoc. 2021;S1525-8610(21)00392-3. doi:10.1016/j.jamda.2021.04.014