Intensive Care Spending May Spiral As Population Ages, Mayo Clinic Study Finds

Spending on intensive care, which today comprises 30-40 percent of hospital costs, may go even higher as the population ages, according to a new Mayo Clinic study. Published in the July issue of Mayo Clinic Proceedings, the study found that older people and those with chronic illnesses have the highest rates of end-of-life intensive care unit (ICU) use.

Given that the country's aging population has an increasing prevalence of chronic diseases, the ICU may be treating more and more people at the end of life, the study's authors say. Edward Seferian, M.D., a Mayo Clinic researcher, pediatric critical care physician and first author of the study, says the findings demonstrate the importance for patients to discuss their end-of-life treatment preferences with their physicians. Health care policy makers should also take note in considering how to fund end-of-life care, Dr. Seferian says. ICU care has been estimated at 1 percent of the U.S. gross domestic product and consumes 30 to 40 percent of hospital costs. While many factors affect intensive care use at the end of life, expanding alternative health care settings, such as nursing homes or hospice care, might be a more cost-effective use of federal health care funding, Dr. Seferian says.

Often patients prefer to spend their final days in a nonhospital setting. The population-based study was set in Olmsted County, Minn., home of Mayo Clinic Rochester, and included 818 residents who had an ICU admission in 1998. Of those, one in five residents died having received ICU care in the last six months of life. Overall, those patients in their last year of life accounted for more than one-fourth of the ICU days used by Olmsted County, Minn., residents during the year. End-of-life ICU use for patients in other regions may be even greater, Dr. Seferian says, as evidenced by higher Medicare spending for inpatient care in other areas of the country.

This study may increase policy makers' concerns, and those of the medical community, about increased demand on health resources by the country's aging population. The proportion of ICU use by residents in their last year of life increased with advancing age. That's no surprise, but Dr. Seferian calls the degree to which this occurred "striking." People age 85 and older in their last year of life used 70 percent of ICU days among that age group, the study found. Among Mayo study patients who died in the ICU, the most common chronic illnesses were congestive heart failure, cancer and renal disease. Chronic heart disease patients had the highest end-of-life ICU admission rate.

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The other author of the intensive care use study was Bekele Afessa, M.D., from Mayo Clinic's Division of Pulmonary and Critical Care Medicine. A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally.

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