Abstract Details

Title Identifying Common Themes in ICU Deaths of Patients with a Diagnosis of Alzheimer Disease

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 9-018

Objective Identify factors that may contribute to a person with Alzheimer disease (AD) being admitted to and dying in an intensive care unit (ICU).

Background Advanced care planning can be very helpful in clarifying goals of care near end of life, which can reduce unnecessary and unwanted interventions and hospitalizations; however, gradually progressive diseases like AD can present specific barriers to such decision-making and potentially increase the likelihood of increased acuity of care at the very end of life.

Design/Methods Utilizing Northwestern’s Enterprise Data Warehouse (EDW), we identified all patients with a diagnosis of AD who died while in the ICU from 2006 to 2016. Chart review was completed to collect basic demographic data, source of ICU admission, presence/absence and timing of a Do Not Resuscitate (DNR) order, and length of stay.

Results Twenty-five individuals had a diagnosis of AD and died while in an ICU at our hospital from 2006 to 2016. Nineteen (76%) were admitted directly from the emergency department (ED). Median length of hospitalization was 2 days with 11 patients (44%) having a stay ≤1 day. Seven (28%) had a length of stay >5 days, with a mean of 22.3 ± 11.5 days. Twenty-one (84%) had a DNR order placed during hospitalization, with 15 (71.4%) of these being placed within less than 2 days of admission.

Conclusions A large portion of patients admitted to the ICU from the ED died within two days, suggesting that momentum of acuity, rather than fully-informed decision-making, drives the rapid escalation of care in these individuals; thus, a potential area for improvement may lie in developing a process by which this momentum can be checked to allow for proper consideration of goals of care. Surrogates who better understand hospitalization outcomes in dementia patients nearing end of life may help slow the momentum before it starts.

Authors/Disclosures
Ian M. Grant, MD (Northwestern University) PRESENTER	No disclosure on file
Borna Bonakdarpour, MD, FAAN (Mesulam Center for Cognitive Neurology and Alzheimer Disease)	Dr. Bonakdarpour has nothing to disclose.

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