Elderly patients nearing the end of their lives are increasingly placed on breathing machines as a sort of automatic reflex among physicians, according to Kei Ouchi, MD, an emergency medicine physician at Boston-based Brigham and Women's Hospital.
"In the heat of the moment in crisis, it is easier for clinicians to just place a patient on a breathing machine," he wrote in an op-ed published in Time. "It can feel like an answer. But it is not always."
Here are five things to know:
1. In 2011, 497,496 older adults in the U.S. received assistance from a breathing machine. This amount is expected to double by 2020, wrote Dr. Ouchi.
"The reason for the popularity of this undesirable process is that, when faced with a life-or-deat decision, selecting the appropriate seriously ill patients who recover from the breathing machine is not straightforward," Dr. Ouchi wrote. "Predicting how much longer the patient will live, managing the acute illness, exploring the values and preferences of the patient and making a recommendation on how to proceed — these actions are complex, especially during a life-or-death situation."
2. Dr. Ouchi published a study in PubMed analyzing the effects of older adults on breathing machines. He analyzed 35,000 patients over age 65 who were placed on breathing machines at 262 hospitals between 2008 to 2015. He found one-third of those patients died in the hospital, while 63 percent of patients were discharged.
3. Dr. Ouchi created an illustration to help physicians engage and visualize deaths caused by breathing machines.
"A clinician may use the illustration to follow along while explaining to a 70-year-old patient that, if ever placed on a breathing machine, she has a one-in-three chance of dying in the hospital, and about equal chance of returning home," he wrote. "This illustration is based on an average of many patients, and the numbers are worse if patients are older or have other serious illnesses like cancer."
4. Placing a patient on a breathing machine "can be means of avoiding a tough, emotional conversation to decipher what the patient or surrogate really want in this situation," Dr. Ouchi wrote. He said both the patient and his or her surrogates must have the cognitive ability to understand the information presented on the graph.
5. Dr. Ouchi said physicians may not be able to "defeat death," but are able to ease a patient's suffering by, "aligning patient's goals to the care that they receive."
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