‘More than one red herring'? Heterogeneous effects of ageing on health care utilisation

Costa‐Font, Joan; Vilaplana-Prieto, Cristina

doi:10.1002/hec.4035

Cited by 12 publications

(9 citation statements)

References 63 publications

(88 reference statements)

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“…However, there may be other reasons or scenarios when withholding and "rationing" intensive care treatment may be deemed appropriate, especially for old people (29). Health economic considerations, which weigh the considerable costs of an intensive care stay with an associated high mortality on the one hand and the high morbidity among the survivors on the other, are understandable and necessary (30,31). However, it is well established, especially in the health economics' literature, that it is not the chronological age, but the remaining life expectancy, that predicts cost and morbidity and that these two are not necessarily the same thing (32).…”

Section: Discussionmentioning

confidence: 99%

ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

Bruno

Wernly²,

Mamandipoor³

et al. 2021

Front. Med.

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Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care.Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted.Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01).Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.

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Section: Discussionmentioning

confidence: 99%

ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

Bruno

Wernly²,

Mamandipoor³

et al. 2021

Front. Med.

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“…Breyer et al (2015) [ 27 ] Pseudo-panel 1997–2009, 2340 age and sex groups Germany Yes (Nadolski (2002) [ 53 ]; Thielscher et al (2012) [ 54 ]; Cylus and Papanicolas (2015) [ 52 ]) No 4. Costa-Font and Vilaplana-Prieto (2020) [ 31 ] Pseudo-panel, waves 1, 2 and 4–7 of SHARE, 288,600 observations 17 countries Yes (the majority of individuals sampled are subject to rationing) No 1 5. De Nardi et al (2016) [ 42 ] Panel 1996–2010, 67,000 Medicare enrollees United States No (Nelson (2011) [ 55 ]) Yes 6.…”

Section: Figure A1mentioning

confidence: 99%

The ‘Red Herring’ Hypothesis: Some Theory and New Evidence

Zweifel

2022

Healthcare

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The ‘red herring’ hypothesis (RHH) claims that apart from income and medical technology, proximity to death rather than age constitutes the main determinant of healthcare expenditure (HCE). This paper seeks to underpin the RHH with some theory to derive new predictions also for a rationed setting, and to test them against published empirical evidence. One set comprising ten predictions uses women’s longer life expectancy as an indicator of the difference in time to death in their favor. Out of 28 testing opportunities drawn from the published evidence, in the case of no rationing seven out of eleven result in full and two in partial confirmation; in the case of rationing, twelve out of 17 result in full and one in partial confirmation. The other set, containing 35 testing opportunities, concerns the age profile of HCE. In the case of no rationing, seven out of twelve result in full and four in partial confirmation; in the case of rationing, eleven out of 23 in full and nine in partial confirmation. There are but ten contradictions in total. Overall, the new tests of the RHH can be said to receive a good deal of empirical support, both from countries and settings with and without rationing.

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“…It is also well known that, rather than the natural age, it is the final stage of a person's life that better determines their use of healthcare resources. [25][26][27] One of the explanatory factors is the cause of death, with oncological diseases being the ones associated with higher expenses. 28 Access to end-of-life healthcare services is highly variable, with the worst impact on the most deprived SEC groups, 29 also being true in the case of access to palliative care.…”

Section: What This Study Addsmentioning

confidence: 99%

Advance directives and real-world end-of-life clinical practice: a case–control study

Dalmau-Bueno

Saura-Lázaro

Busquets

et al. 2021

BMJ Support Palliat Care

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BackgroundAdvance directives (ADs) have been legally regulated to promote autonomy over health decisions among patients who later lose decision-making capacity.Aims and objectivesTo analyse the differences in clinical practice at end of life among people who had completed an AD versus those who had not.MethodsRetrospective case–control study (1:2), matched by age, sex, year, cause of death and region of residence. The data sources used were the ADs registry, central registry of insured persons, hospital discharge, pharmacy and billing databases, and the mortality registry. Conditional logistic regression models (crude and adjusted by socioeconomic level) were performed. The outcome variable was the frequency of medical procedures performed during the last year of life.Results1723 people with ADs who died in Catalonia during 2014–2015 were matched with 3446 dead controls (without ADs). Thoracentesis was the procedure with the greatest reduction among women with an AD (adjusted OR (ORadj) 0.54, 95% CI: 0.32 to 0.89) in conjunction with artificial nutrition (ORadj 0.54, 95% CI: 0.31 to 0.95). Intubation was the procedure with the greatest reduction (ORadj 0.56, 95% CI: 0.33 to 0.94) among men. Slight differences could be seen in the case of cancer deaths. There were no relevant differences when adjusting by socioeconomic level.ConclusionsADs are an effective tool to adjust the realisation of some procedures at end of life. These results can help better plan for the treatment of patients with ADs, as well as increase the awareness among clinical personnel, families and the general population.

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‘More than one red herring'? Heterogeneous effects of ageing on health care utilisation

Cited by 12 publications

References 63 publications

ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock

The ‘Red Herring’ Hypothesis: Some Theory and New Evidence

Advance directives and real-world end-of-life clinical practice: a case–control study

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