The enormous cost we pay for our final days

[okarol]

The enormous cost we pay for our final days
Julie Robotham
December 4, 2010

THE use of intensive-care beds by people over 80 has doubled in just one decade and now accounts for 12 per cent of all intensive-care use in Australia, according to data that doctors say illustrates an unsustainable trend towards aggressive treatment of seriously ill people near the end of their lives.

In 2007 the over-65s consumed nearly half of all days spent in intensive-care beds - intended to support people through critical illnesses from which they have a reasonable chance of recovery.

More than a quarter of intensive-care beds could be occupied by the over-80s by 2030 if the trend continues, and a 50 per cent increase would be required as early as 2020, according to a study published last year in the journal Critical Care and Resuscitation.
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Associate Professor Gillian Bishop, the director of Campbelltown Hospital's intensive-care unit, says the trend towards much older people being treated in intensive care reflects ''expectations of what their lives should be like … Because we don't discuss dying, people are not so happy to die without some therapy being offered.''

Bishop says when very frail and elderly people are suddenly taken ill, doctors should consider offering a strict 24-hour trial of intensive care - which costs $3000 a day compared to about $1000 for an ordinary hospital stay - on the understanding it will be withdrawn if the person's condition does not improve.

''The thing that brings [families] round is time,'' Bishop says.

But reconciling families to the loss of their loved one is not a good use of the costliest care, she says. ''We can't afford it; we need to be very blunt and say we can't afford this use of an incredibly expensive resource.''

Intensive care can hugely inflate the cost of caring for the dying, adding to hospital costs that are already skewed to the last weeks of life.

In a 2007 analysis of hospital spending on older people in the last year of their life, researchers from NSW Health and the University of Western Sydney found ''average inpatient costs increased greatly in the six months before death, from $646 per person in the sixth month to $5545 in the last month before death''.

The hospital care of the oldest people - those aged 95 or above - was less than half as expensive as that of people aged 65 to 74, on whom an average $17,927 was spent in the year before they died.

http://www.smh.com.au/lifestyle/wellbeing/the-enormous-cost-we-pay-for-our-final-days-20101203-18ju5.html

[MooseMom]

This issue is emotionally fraught.  My mom spent the last 16 days of her life this past summer in intensive care.  I spent 9 of those days with her, so I could see everything that was going on.  It was obvious to me from the very beginning that my mom wouldn't survive, but they threw everything they had at her.  On top of all of the treatments, they were dialyzing her, too.  I will never forget the tortured look she had in her eyes.  You naturally want your mom to be treated, but you don't want her to be tortured, either.  It was just horrible.

We as a society decide how to spend our money.  Ultimately, we form our government and give it direction on how to spend our tax dollars.  My mom's very expensive treatment that didn't cure her in the end was paid for by Medicare, ie, the American people, and it is the American people who have decided that such expensive treatment is worth it.  If we change our minds and decide that the amount Medicare spends on our sickest elderly people is too much, then that's fair enough, but then WE become the "death panels".

Again, the issue isn't really age.  If you are 80 but in good health, time spent in ICU can put you back on your feet.  If you are 50 and in the final stages of Huntington's, ICU won't help you.  So it's not age that is the issue, rather, it's prognosis and a whole host of other factors.

I know that things are different in Australia, but Medicare is publically funded just like the health system in Australia, so the issues are basically the same.   

[jbeany]

My mom died in ICU as well.  She was just 60, so the age wasn't the issue, but I agree with MM, the diagnosis was fatal, so why did they transfer her?  Her liver had failed, she was too far gone for a transplant, and there was no reason whatsoever that they needed to transfer her to ICU except that my Dad didn't want to end it until we were all there.  Honestly, I could have done without the memory of listening to the heart monitor slow down and stop beeping.