About 20% of Americans die in intensive care units (ICUs), even though 90% say they'd prefer to die at home, according to a large study of inpatients in nonfederal hospitals. Noting that the number of people over age 65 will double by 2030, researchers say ICU care providers must be able to offer "appropriate, compassionate end-of-life care." But doing so, they say, is difficult unless ICU staff have the training and time to provide such care.

To gather their data, researchers looked at deaths and hospital discharges in 1999 in Florida, Massachusetts, New Jersey, New York, Virginia, and Washington. About 38% of all deaths occurred in hospitals. And about 22% of all people who died did so in an ICU or had recently received intensive care.

Infants were most likely to receive intensive care and people age 85 and older were least likely to receive intensive care. The age-specific rate of death was highest for infants (43%). It ranged from 18% to 26% for older children and adults up to age 85, and fell to 14% for adults over age 85.

The researchers call for "a systemwide expansion in ICU care for dying patients unless the health care system pursues rationing, more effective advanced care planning, and augmented capacity to care for dying patients in other settings."

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