Researchers: Tzvi Dwolatzky¹, Bella Smolin¹, Ayelet Raz-Paster¹, Leon Levi¹, Tatiana Mashiach¹, Daniel King¹

Background: Aging of the population is associated with increased morbidity. Technological developments have made an important impact on promoting longevity and prolonging life. Mechanical ventilation is widely available and used for respiratory support, and this has resulted in increasing numbers of older ventilated patients in Internal Medicine Departments, placing greater demands on the health system both in acute and chronic care.

Objectives: The aim of our study was to determine the factors involved in the decision-making process leading to mechanical ventilation of older people, and to evaluate the results of mechanical ventilation in patients treated in Internal Medicine Departments.

Method: We performed a prospective observational study over a period of 18 months. Over this period, all patients aged 65 years and older who received respiratory support by means of mechanical ventilation and who were treated in one of the five Internal Medicine Departments or in the Medical Intensive Care Unit at the Rambam Health Care Campus were included. Demographic and medical data were collected as well as details regarding the decision-making process and outcomes.

Findings: Our study population included 619 patients, 568 of whom were ventilated for the first time, 25 were chronically ventilated, and 26 were reventilated. Mean age was 78.5 years, 42% were in the 8th decade, 32% in their 9th decade, and 6.8% were 90 years and older. There were 299 (48%) women and 320 (52%) men. Outcome was poor, with 60.6% in-hospital mortality.

Conclusions: Mechanical ventilation is initiated for respiratory support even at advanced old age. Poor survival and outcome emphasize the need to re-evaluate the use of mechanical ventilation as a life-saving measure in patients at the end of life.

Recommendations: The policy regarding the use of mechanical ventilation in older patients with life-threatening conditions, especially by paramedics in the community, should be carefully re-evaluated.

Research end date: 11/2017