ICU admission preferences in the hypothetical event of acute critical illness: A survey of very old Norwegians and their next-of-kins

Abstract Purpose We aimed to explore older patients’ intensive care unit (ICU) admission preferences and their next-of-kins’ ability to predict these preferences. Methods We conducted a self-administered survey of a purposive sample of outpatients ≥ 80 years regarded as potential ICU candidates, and of their next-of-kins. We asked about the patients’ ICU admission preferences in three hypothetical scenarios of acute critical illness. Next-of-kin respondents were asked to make a proxy statement of the older respondent’s wishes regarding ICU admission. For each treatment choice, all respondents could provide their level of confidence. Additionally, we sought to identify demographic and healthcare-related characteristics that potentially influenced ICU admission preferences and proxy accuracy. Results Of 202 outpatients ≥ 80 years, equal proportions opted for (39%, CI 33–45%) and against (40%, CI 34–46%) ICU admission, and one in five (21%, CI 17–26%) did not wish to engage decision-making. Male gender, religiosity, and prior ICU experience increased the likelihood of older respondents opting for ICU admission. Although next-of-kins’ proxy statements had only weak agreement with the older respondents ICU admission preferences (52%, CI 45–59%), they significantly agreed with the next-of-kins’ own ICU admission preferences (79%, CI 73–84%). Decisional confidence was high for both older and the next-of-kin respondents. Conclusion There was substantial variation in the ICU admission preferences of very old patients. Although next-of-kins’ proxy statements regarding ICU admission preferences only weakly agreed with those of the older respondents, next-of-kins’ and older respondents’ confidence levels in rendering these judgments were high.