Absence of ageism in access to critical care: a cross-sectional study

BACKGROUND: in recent years, the NHS has been accused of ageism frequently and from many fronts. Previous studies have shown that the number of critical care beds in the UK is inadequate to meet the needs of the population. This study asks whether there is discrimination against older people in access to these critical care beds. METHODOLOGY: all sick patients in five hospitals in a South Wales Health Authority were studied every 12th day for one calendar year. Demographic, clinical and physiological data were collected. Ten members of the Welsh Intensive Care Society subsequently judged the optimum location of care for each of these individuals. This was based on a summary of diagnoses, procedures and physiological/biochemical results, but without access to the age of the patient or type of ward or hospital where the patients was actually treated. These data were analysed to determine whether the likelihood of being treated in the most appropriate setting, based on the consensus decision, was influenced by the patient's age. RESULTS: 4058 patients met the study criteria, of whom 2287 patients (56.4% of the total) were being cared for on a general ward and 1769 in critical care areas. The intensivist panel determined that 1085 (53%) ward based patients were more suitable for care on intensive care or high dependency units and 220 (12.4%) critical care patients were suitable for ward care. The proportion of patients considered to be in an inappropriate ward varied little in different age groups. DISCUSSION: many patients on general wards have needs that may be more appropriately addressed on critical care units but there is no relationship between these unmet needs and the age of the patient.