Study Questions Common Practice of Intubating Elderly Patients

As elderly patients near the end of life they are frequently intubated and put on a ventilator to help them breathe, extending life. But is this common medical intervention what patients would want for themselves?  A new study questions if this time-honored practice is in the best interest of the patient and if families really understand the implications. 

According to a recent report in the New York Times, a study , published in the Journal of  the American Geriatrics Society, found that more than a third of patients over the age of 65 who are put on ventilators in hospital die.  And what’s more, only a quarter of these patients return home; most (63 per cent) will be moved into nursing facilities.  Many will suffer a decline in function following the procedure or die within the next year.

Lead researcher Dr. Kei Ouchi stresses the importance of explaining intubation and it’s possible outcomes to families so they can better honor the wishes of their loved one, who may not want to be put on a breathing machine, sedated and unable to communicate, especially if they are not expected to survive beyond a few days or weeks.   Discussions about end-of-life care should ideally be held with older loved-ones before a crisis, but it doesn’t always unfold that way.  And families are often left to make difficult decisions during an emotional time of crisis. 

With greater longevity and an impending silver tsunami of seniors making up a growing share of the world’s population, it is expected that the rate of intubations will rise in the coming years.  But there are alternatives to using a ventilator on patients who are having difficulty breathing or are in respiratory distress.  A bipap (bi-level positive airway pressure) machine can help patients breathe but does not cause discomfort requiring sedation and the mask can be removed for short periods of time to talk or take a drink.  This allows for conversations to take place between patients, loved ones and doctors about what the future holds and what medical interventions should or should not be carried out.

Read more about how doctors and families can work together to help elderly patients experience a better death and be given the opportunity to say a final goodbye to those they love in the June 2018 issue of JAMA Internal Medicine.