Development and Evaluation of a Family-Partnered Care Pathway for Critically Ill Older Patients

ABSTRACT: As society ages, increasing numbers of older patients are being admitted to Intensive Care Units (ICU) for life-sustaining treatments. Historically, older critically ill patients have been systematically excluded from many clinical trials so there is very little evidence to inform what best practices should be for this population when admitted to ICU. We have conducted several observational studies of older adults suffering from critical illness and determined that there are many problems with communication and decision-making, and that the care provided is often not based on patient/family wishes or values. In some cases, this leads to a poor end of life care, a prolonged dying experience and family dissatisfaction. Moreover, older patients who do survive their critical illness often have poor recoveries. Our team proposes to generate new evidence and synthesize existing evidence in order to create a family-partnered care pathway to define the best care that older patients should receive in ICU, and as they recover from their critical illness. Our focus is on improving communication and decision-making with these patients and their families and ensuring that optimal rehabilitation practices are being realized for those that survive and optimal end of life practices for those who die. We will work actively with our stakeholder groups, including patient and family representatives, researchers, clinicians and healthcare administrators to build knowledge translation (KT) capacity to ensure care is informed by best evidence. We will test this pathway in the province of Alberta and subsequently implement nationwide. The knowledge we generate has the potential to impact quality care for older, sick, vulnerable patients and their families in Canada and, working with our partners, can significantly impact care worldwide.