Intensive care unit admissions among persons with dementia: Overuse or underuse?

Plain Language Summary

Decision-making to provide intensive hospital care to persons with dementia should consider clinical, ethical, and human rights. Allocating resources appropriately while respecting people’s wishes is a challenging process. Risks exist for both overuse and underuse of intensive care among persons with dementia.

One in six persons with dementia experiences burdensome hospital transitions while nearing end-of-life. Such transitions are often undesired and stressful, can lead to further physical and cognitive deterioration, and often involve painful interventions. Conversely, persons with dementia might be inappropriately denied access to intensive care outright, especially when resources are scarce which was the case during the COVID-19 pandemic outbreak.

Thus, we aimed to understand the appropriateness (i.e., potential overuse and underuse) of intensive unit care among persons with dementia. We described rates of intensive care unit admissions in three Canadian provinces (Ontario, Quebec, Alberta) in 2019 and measured the change in admission rates during the first two waves of the pandemic compared to the corresponding periods in 2019.

We observed different pre-pandemic intensive care unit admission rates among persons with dementia in the three provinces. We found significant reductions in the rates of intensive care unit admissions during the first two pandemic waves compared to the corresponding pre-pandemic periods in person with dementia living in both the community and nursing homes.

These findings require further research to understand the appropriateness of these intensive care unit admissions. Recommendations to ensure respect for the dignity of persons with dementia should be implemented when planning access to scarce resources, including making individualized decisions, discussing goals of care, considering expected survival, and not making assumptions about life expectancy and quality of life based on the label of “dementia”.