Quality of life in patients aged 80 or over after ICU discharge

Characteristics and outcomes of patients screened by the rapid response team and transferred to intensive care unit in South Korea

The rapid response system (RRS) is associated with a reduction in in-hospital mortality. This study aimed to determine the characteristics and outcomes of patients transferred to the intensive care unit (ICU) by a rapid response team (RRT). This retrospective, multicenter cohort study included patients from nine hospitals in South Korea. Adult patients who were admitted to the general ward (GW) and required RRS activation were included. Patients with do-not-resuscitate orders and without lactate level or Sequential Organ Failure Assessment score were excluded. A total of 8228 patients were enrolled, 3379 were transferred to the ICU. The most common reasons for RRT activation were respiratory distress, sepsis and septic shock. The number of patients who underwent interventions, the length of hospital stays, 28-day mortality, and in-hospital mortality were higher in the ICU group than in the GW group. Factors that could affect both 28-day and in-hospital mortality included the severity score, low PaO2/FiO2 ratio, higher lactate and C-reactive protein levels, and hospitalization time prior to RRT activation. Patients admitted to the ICU after RRT activation generally face more challenging clinical situations, which may affect their survival outcomes.

Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.

The correlation between death anxiety, loneliness and hope levels in patients treated in the cardiac intensive care unit

BACKGROUND

A sense of hope plays an important role in relieving stress and psychological distress of cardiology patients, as well as improving their physical well-being.

AIM

The aim of this study is to investigate the correlation between death anxiety, loneliness and hope levels in patients receiving treatment in a cardiac intensive care unit (ICU).

DESIGN

This is a prospective, descriptive and correlational study.

METHODS

The study was completed with 150 cardiac ICU patients in Istanbul, Turkey. The data were collected using a Patient Information Form, the Templer Death Anxiety Scale (TDAS), the Herth Hope Index (HHI) and the UCLA Loneliness Scale (UCLA-LS).

RESULTS

The patients had a mean age of 63.56 ± 12.74 years. Most of the patients (82%) were treated in the ICU for heart failure. There was a statistically significant positive correlation between total scores of TDAS and UCLA-LS (r = .337; p < .001) and a statistically significant negative correlation between total scores of UCLA-LS and HHI (r = -.292; p < .001). Also, there was a statistically significant negative correlation between the scores of UCLA-LS and Positive Readiness and Expectancy Subscale (r = -.164; p = .044). The multiple linear regression indicated that the model was statistically significant (F = 7.177, p < .001). The variables of age and UCLA-LS among those included in the model were statistically significant predictors of the death anxiety scores of the patients (23.1%) (p < .05).

CONCLUSIONS

The cardiology patients who received treatment in the ICU had a high level of death anxiety and moderate levels of loneliness and hope. The age and loneliness level were statistically significant predictors of death anxiety.

RELEVANCE TO CLINICAL PRACTICE

It is recommended that individualized nursing care be planned and provided to conscious cardiology patients who are treated in the ICU, considering their age and loneliness levels and that nursing care be planned for individuals who are at risk of fear, anxiety, loneliness and hopelessness by periodically assessing their death anxiety, loneliness and hope levels.

Comparison of the Incidence of Post-intensive Care Syndrome (PICS) Between Elderly and Non-elderly Patients: A Subgroup Analysis of the Japan-PICS Study

AIM

The aging society is expanding, and more elderly patients are admitted to intensive care units (ICUs). Elderly patients may have increased ICU mortality and are thought to have a high incidence of post-intensive care syndrome (PICS). There are few studies of PICS in the elderly. This study hypothesized that the elderly have an increased incidence of PICS compared to the non-elderly.

METHODS

This is a subgroup analysis of a previous multicenter prospective observational study (Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: The Japan-PICS study) conducted from April 2019 to September 2019. Ninety-six patients were included who were over 18 years old, admitted to the ICU, and expected to require mechanical ventilation for more than 48 hours. Physical component scales (PCS), mental component scales (MCS), and Short-Memory Questionnaire (SMQ) scores of included patients were compared before admission to the ICU and six months later. The diagnosis of PICS required one of the following: (1) the PCS score decreased ≧10 points, (2) the MCS score decreased ≧10 points, or (3) the SMQ score decreased by >40 points. Patients were classified as non-elderly (<65 years old) or elderly (≧65 years old), and the incidence of PICS was compared between these two groups.

RESULTS

The non-elderly (N=27) and elderly (N=69) groups had incidences of PICS: 67% and 62% (p=0.69), respectively.

CONCLUSION

There is no statistically significant difference in the incidence of PICS in the non-elderly and elderly.

A scoping review of older patients' health-related quality of life, recovery and well-being after intensive care

AIMS

In the present study, we aimed to determine how Health-Related Quality of Life (HRQoL), recovery (function and capacity in daily life) and well-being are followed up and characterised in persons ≥65 years of age who were being cared for in an intensive care unit (ICU).

DESIGN

A scoping review.

METHODS

CINAHL, MEDLINE (Ovid) and PsycINFO databases were searched in October 2021. 20 studies met the inclusion criteria. The scoping review followed the principles outlined by Arksey and O'Malley, and the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) checklist and Joanna Briggs Institute (JBI) framework were used.

RESULTS

Results are presented under five subheadings: Study characteristics, Type of studies, Methods for follow-up, health-related quality of life, and Recovery. Time seems to be an important factor regarding HRQoL among older patients being cared for in an ICU, with most elderly survivors perceiving their HRQoL as acceptable after 1 year. Nevertheless, several studies showed patients' willingness to be readmitted to the ICU if necessary, indicating that life is worth fighting for.

PATIENT OR PUBLIC CONTRIBUTION

Due to the design of the study, this study involves no patient or public contribution.

The impact of unexpected intensive care unit admission after cancer surgery on long-term symptom burden among older adults: a population-based longitudinal analysis

BACKGROUND

Older adults are at high-risk for a post-operative intensive care unit (ICU) admission, yet little is known about the impact of these admissions on quality of life. The objective of this study was to evaluate the impact of an unexpected post-operative ICU admission on the burden of cancer symptoms among older adults who underwent high-intensity cancer surgery and survived to hospital discharge.

METHODS

We performed a population-based cohort study of older adults (age ≥ 70) who underwent high-intensity cancer surgery and survived to hospital discharge in Ontario, Canada (2007-2017). Using the Edmonton Symptom Assessment System (ESAS), a standardized tool that quantifies patient-reported physical, mental, and emotional symptoms, we described the burden of cancer symptoms during the year after surgery. Total symptom scores ≥ 40 indicated a moderate-to-severe symptom burden. Modified log-Poisson analysis was used to estimate the impact of an unexpected post-operative ICU admission (admission not related to routine monitoring) on the likelihood of experiencing a moderate-to-severe symptom burden during the year after surgery, accounting for potential confounders. We then used multivariable generalized linear mixed models to model symptom trajectories among patients with two or more ESAS assessments. A 10-point difference in total symptom scores was considered clinically significant.

RESULTS

Among 16,560 patients (mean age 76.5 years; 43.4% female), 1,503 (9.1%) had an unexpected ICU admission. After accounting for baseline characteristics, patients with an unexcepted ICU admission were more likely to experience a moderate-to-severe symptom burden relative to those without an unexpected ICU admission (RR 1.64, 95% CI 1.31-2.05). Specifically, among patients with an unexcepted ICU admission the average probability of experiencing moderate-to-severe symptoms ranged from 6.9% (95 CI 5.8-8.3%) during the first month after surgery to 3.2% (95% CI 0.9-11.7%) at the end of the year. Among the 11,229 (67.8%) patients with multiple ESAS assessments, adjusted differences in total scores between patients with and without an unexpected ICU admission ranged from 2.0 to 5.7-points throughout the year (p < 0.001).

CONCLUSION

While unexpected ICU admissions are associated with a small increase in the likelihood of experiencing a moderate-to-severe symptom burden, most patients do not experience a high overall symptom burden during the year after surgery. These findings support the role of aggressive therapy among older adults after major surgery.

Impact on 6-month outcomes of hospital trajectory in critically ill older patients: analysis of the ICE-CUB2 clinical trial

Background

Little is known about the impact of hospital trajectory on survival and functional decline of older critically ill patients. We evaluate 6-month outcomes after admission to: intensive care units (ICU), intermediate care units (IMCU) or acute medical wards (AMW).

Methods

Data from the randomised prospective multicentre clinical trial ICE-CUB2 was secondarily analysed. Inclusion criteria were: presenting at emergency departments in critical condition; age ≥ 75 years; activity of daily living (ADL) ≥ 4; preserved nutritional status; and no active cancer. A Cox model was fitted to compare survival according to admission destination adjusting for patient characteristics. Sensitivity analysis using multiple imputation for missing data and propensity score matching were performed.

Results

Among 3036 patients, 1675 (55%) were women; median age was 85 [81–99] years; simplified acute physiology score (SAPS-3) 62 [55–69]; 1448 (47%) were hospitalised in an ICU, 504 in IMCU (17%), and 1084 (36%) in AMW. Six-month mortality was 629 (44%), 155 (31%) and 489 (45%) after admission in an ICU, IMCU and AMW (p < 0.001), respectively. In multivariate analysis, AMW admission was associated with worse 6-month survival (HR 1.31, 95% CI 1.04–1.63) in comparison with IMCU admission, after adjusting for age, gender, comorbidities, ADL, SAPS-3 and diagnosis. Survival was not significantly different between patients admitted in an ICU and an IMCU (HR 1.17, 95% CI 0.95–1.46). Sensitivity analysis using multiple imputation for missing data and propensity score matching found similar results. Hospital destination was not significantly associated with the composite criterion loss of 1-point ADL or mortality. Physical and mental components of the 12-Item Short-Form Health Survey were significantly lower in the acute medical ward group (34.3 [27.5–41.7], p = 0.037 and 44.3 [38.6–48.6], p = 0.028, respectively) than in the ICU group (34.7 [28.4–45.3] and 45.5 [40.0–50.0], respectively) and IMCU group (35.7 [29.7–43.8] and 44.5 [39.7–48.4], respectively).

Conclusions

Admission in an AMW was associated with worse 6-month survival in older critically ill patients in comparison with IMCU admission, with no difference of survival between ICU and IMCU admission. There were no clinically relevant differences in quality of life in each group. These results should be confirmed in specific studies and raise the question of dedicated geriatric IMCUs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-022-01042-4.

Intensive care of geriatric patients-a thin line between under- and overtreatment

Demographic developments are leading to an ever-increasing proportion of elderly and aged patients in hospitals at all levels of care, and even more patients from these age groups are to be expected in the future. Based on the projected population development, e.g., in Norway, an increase in intensive care beds of between 26 and 37% is expected by 2025. This poses special challenges for the treatment and management of geriatric intensive care patients. The acute illness is not the only decisive factor, but rather the existing multimorbidity and functional limitations of this vulnerable patient group must likewise be taken into account. Age per se is not the sole determinant of prognosis in critical patients, even though mortality increases with age.

Prognosis of Very Elderly Patients after Intensive Care

Elderly patients (over age 85) are increasingly treated in Intensive Care Units (ICU), despite doctors’ reluctance to accept these frail patients. There are only few studies describing the relevance of treatments for this group of patients in ICU. One of these studies defined an age of 85 or over as the essential admittance criterion. Exclusion criteriwere low autonomy before admittance or an inability to answer the phone. Epidemiological data, history, lifestyle, and autonomy (ADL score of six items) were recorded during admission to the ICU and by phone interviews six months later. Eight French ICUs included 239 patients aged over 85. The most common diagnostics were non-cardiogenic lung disease (36%), severe sepsis/septic shock (29%), and acute pulmonary oedem (28%). Twenty-three percent of patients were dependent at the time of their admission. Seventy-one percent of patients were still alive when released from ICU, and 52% were still alive after 6 months. Among the patients which were non-dependent before hospitalization, 17% became dependent. The only prognostic criterifound were the SAPS II score on admission and the place of residence before admission (nursing home or family environment had poor prognosis). Although the prognosis of these elderly patients was good after hospitalization in ICU, it should be noted that the population was carefully selected as having few comorbidities or dependence. No triage critericould be suggested.

Self-perceived recovery and quality of life in elderly patients surviving ICU-admission for abdominal sepsis

Introduction

Concern for loss of physical performance and Health-Related Quality of Life (HRQoL) may raise doubts regarding the meaningfulness of an Intensive Care (ICU) admission in elderly patients. We evaluated self-perceived long-term recovery and satisfaction in elderly surviving an abdominal sepsis related ICU-admission and related this to objective measures of HRQoL.

Methods

A cross-sectional survey study was performed in all ICU-survivors with age ≥70 admitted with abdominal sepsis. HRQoL, frailty and self-perceived long-term recovery were measured using the EQ-5D-3L, Groningen Frailty Indicator, and a self-developed questionnaire, respectively.

Results

Of 144 patients admitted, 48 were alive at follow up (2.42 [0.92; 3.83] years), and 29 (60%) returned the survey. Eleven patients out of 29 (38%) recovered to baseline functioning, and reported higher HRQoL compared to unrecovered patients (0.861 [0.807; 1.000] and 0.753 [0.499; 0.779] respectively, p=0.005). Of the unrecovered patients, 53% were satisfied with their functioning, and 94% were willing to return to ICU.

Conclusions

Mortality in elderly patients with abdominal sepsis is high and ICU-admission should be weighed carefully. However, despite substantial functional decline in survivors, it does not necessarily cause self-perceived unsatisfactory functioning, poor HRQoL and unwillingness to receive life-sustaining therapy again. Caution is advised to use an anticipated loss of functioning as an argument to deny an ICU-admission.

Clinical characteristics and outcomes of mechanically ventilated elderly patients in intensive care units: a Chinese multicentre retrospective study

Background

In recent years, the number of elderly patients receiving mechanical ventilation (MV) in intensive care units (ICUs) has increased. However, the evidence on the outcomes of elderly mechanically ventilated patients is scant in China. Our objective was to evaluate the characteristics and outcomes in elderly patients (≥65 years) receiving MV in the ICU.

Methods

We performed a multicentre retrospective study involving adult patients who were admitted to the ICU and received at least 24 hours of MV. Patients were divided into three age groups: under 65, 65-79, and ≥80 years. The primary outcome was hospital mortality. We performed univariate and multivariate logistic regression analysis to identify factors associated with hospital mortality.

Results

A total of 853 patients were analysed. Of those, 61.5% were ≥65 years of age, and 26.0% were ≥80 years of age. There were significant differences in the principal reason for MV among the three age groups (P<0.001). Advanced age was significantly associated with total duration of MV, ICU length of stay (LOS), and ICU costs (all P<0.001), but not with hospital LOS and hospital costs (P>0.05). In addition, mortality rates in the ICU, hospital, and at 60 days significantly increased with age (all P<0.001). In the age group of 80 years and older, the mortality rates were 47.7%, 49.5%, and 50.0%, respectively. Multivariate logistic regression analysis had found that age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO₂/FiO₂) ratio, total duration of MV, ICU LOS, and the decision to withhold/withdraw life-sustaining treatments were independent influence factors for mortality rates.

Conclusions

Mechanically ventilated elderly patients (≥65 years) have a higher ICU and hospital mortality, but the hospital LOS and hospital costs are similar to younger patients. Advanced age should be considered as a significant independent risk factor for hospital mortality of mechanically ventilated ICU patients.

Epidemiology and outcomes of elderly patients requiring renal replacement therapy in the intensive care unit: an observational study

Background

Renal replacement therapy (RRT) in critically ill patients is associated with high morbidity and mortality. The appropriateness of RRT initiation is sometimes questioned in elderly patients. Therefore, we sought to evaluate the long-term mortality, dialysis dependence and quality of life (QOL) of elderly patients who survived critical illness requiring RRT.

Methods

This is a monocentric observational study including all patients > 55 yo who received RRT for acute kidney injury in our intensive care unit (ICU) between January 2015 and April 2018. At the time of the study (May 2019), we assessed if they were still alive by cross referencing our hospital database and the Swiss national death registry. We sent survivors written information and, subsequently, contacted them over the phone. We obtained their consent for participation, asked about their dialytic status and performed an EQ-5D survey with visual analog scale (VAS). Results were stratified according to their age at the time of ICU admission (G1: “55–65 yo”; G2: “> 65–75 yo” and G3: “> 75 yo”). QOL in G3 patients were compared to G1 and G2 and to predicted values.

Results

Among the 352 eligible patients, 171 died during the index hospital admission. After a median follow-up time of 32.7 months (IQR 19.8), a further 62 had died (median time to death for ICU survivors 5.0 (IQR 15.0) months. Hence, 119 (33.6%) patients were still alive at the time of the study. We successfully contacted 96 (80.7%) of them and 83 (69.7%) were included in the study (G1: 24, G2: 44 and G3: 15). Only 6 (7.2%) were RRT dependent. Patients in G3 had lower EQ-5D and VAS scores than those in G1 and G2 (p < 0.01). These scores were also significantly lower than predicted values (p < 0.05).

Conclusions

RRT patients have a very high in-hospital and post discharge mortality. Among survivors, RRT dependency was low. Irrespective of baseline values, patients > 75 yo who survived ICU had a lower QOL than younger patients. It was lower than predicted according to age and sex. The appropriateness of RRT initiation in elderly patients should be discussed according to their pre-existing QOL and frailty.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02302-4.

Health-related Quality of Life Evaluated by MOS SF-36 in the Elderly Patients 1 Month before ICU Admission and 3 Months after ICU Discharge

Objectives

The aims of this study were to evaluate changes in health-related quality of life (HRQoL) before ICU admission and after ICU discharge in elderly patients and to determine predictors of this HRQoL.

Materials and methods

This prospective study has been realized in the medical ICU (August 2012-March 2013). All patients 65 years of age or older who were hospitalized for ≥48 hours in our medical ICU have been included. The HRQoL was assessed 1 month prior to ICU admission in all the patients at admission and 3 months after ICU discharge for survivors using the Arabic version of MOS SF-36 questionnaire.

Results

We enrolled 118 patients (66 M: 55.9% and 52 F: 44.1%). The mean age was 72 ± 6 years. ICU mortality rate was 47.5% and three-month mortality rate was 55.1%. The reliability and validity of MOS SF-36 were satisfactory. Among the 53 survivors at follow-up, the subscales of MOS SF-36 decreased significantly at 3 months after ICU stay except the “Bodily Pain”. The physical component score (PCS) and mental component score (MCS) decreased also significantly. The independent factors strongly associated with PCS and its variations were: age (β = −1.56, p = 0.001), prior functional status (β = −22.10, p = 0.002) and SAPSII (β = −0.16, p = 0.04). For MCS, these factors were: live alone (β = 16.50, p = 0.006), previous functional status (β = −9.09, p = 0.008) and existence of education level (β = 2.98, p = 0.037).

Conclusion

We demonstrated a fall in the physical and psychical aspects of HRQoL 3 months after ICU discharge in the elderly patients. In addition to factors such as age, prior functional status and severity of illness, family status and educational level seem decisive in the post-ICU HRQoL.

How to cite this article

Zeggwagh Z, Abidi K, Kettani MNZ, Iraqi A, Dendane T, Zeggwagh AA. Health-related Quality of Life Evaluated by MOS SF-36 in the Elderly Patients 1 Month before ICU Admission and 3 Months after ICU Discharge. Indian J Crit Care Med 2020;24(7):531–538.

Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity score-matched cohort study

Background

Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the 2 years after discharge in mortality, healthcare utilisation and frailty score between elderly survivors of ARI in the ICU and an elderly control population.

Methods

We used 2009–2017 data from 39 hospital discharge databases. Patients ≥ 80 years old discharged alive from ICU hospitalisation for acute respiratory infection were propensity score-matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilisation and frailty scores in the 2-year periods before and after ICU hospitalisation.

Results

One thousand two hundred and twenty elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95% CI, 6.1–17.3] higher risk of death at 6 months and 3.6-fold [95% CI, 2.9–4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilisation and frailty score in the 2 years after hospital discharge, whereas healthcare utilisation and frailty scores among controls were stable before and after hospitalisation.

Conclusions

We observed a substantially increased rate of death in the years following ICU hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.

Outcomes of Intensive Care Patients Older Than 90 Years: An 11-Year National Observational Study

BACKGROUND/OBJECTIVES

Many intensive care unit (ICU) physicians are reluctant to admit patients aged 90 years and older, although evidence to support these decisions is scarce. Although the body of evidence on outcomes of patients aged 80 years and older is growing, it does not include patients aged 90 years and older. The aim of this study was to compare the short- and long-term mortality of ICU patients aged 90 years and older in the Netherlands with ICU patients aged 80 to 90 years, that is, octogenarians.

DESIGN

Multicenter national cohort study over an 11-year period (2008-2018), using data of the National Intensive Care Evaluation (NICE) registry and the Dutch insurance claims registry.

SETTING

All 82 ICUs in the Netherlands.

PARTICIPANTS

All patients aged 80 years and older at the time of ICU admission.

MEASUREMENTS

A total of 104,754 patients aged 80 years and older, of whom 9,495 (9%) were 90 years and older, were admitted to Dutch ICUs during the study period.

RESULTS

ICU mortality of the patients aged 90 years and older was lower (13.8% vs 16.1%; P < .001) and hospital mortality was similar (26.1% vs 25.7%; P = .41) compared with octogenarians. After 3 months, mortality was higher for the patients aged 90 years and older (43.1% vs 33.7%; P < .001) and after 1-year mortality was 55.0% vs 42.7%; P < .001.

CONCLUSION

In the Netherlands, mortality rates of patients aged 90 years and older admitted to the ICU are not as disappointing as often assumed. They have a lower ICU mortality and a similar hospital mortality compared with octogenarians. Nevertheless, their longer term mortality is higher compared with octogenarians. However, almost 3 of 4 patients leave the hospital alive, and almost half of the patients aged 90 years and older are still alive 1 year after their ICU admission. J Am Geriatr Soc 68:1842-1846, 2020.

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Background

The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival.

Results

This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81–86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86–1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87–1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7–60.7) vs. 57.1% (95% CI 53.7–60.1), p = 0.85].

Conclusions

After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.

Demographic Shifts, Case Mix, Activity, and Outcome for Elderly Patients Admitted to Adult General ICUs in England, Wales, and Northern Ireland

OBJECTIVES

Major increases in the proportion of elderly people in the population are predicted worldwide. These population increases, along with improving therapeutic options and more aggressive treatment of elderly patients, will have major impact on the future need for healthcare resources, including critical care. Our objectives were to explore the trends in admissions, resource use, and risk-adjusted hospital mortality for older patients, admitted over a 20-year period between 1997 and 2016 to adult general ICUs in England, Wales, and Northern Ireland.

DESIGN

RETROSPECTIVE ANALYSIS OF NATIONAL CLINICAL AUDIT DATABASE.

SETTING

The Intensive Care National Audit & Research Centre Case Mix Programme Database, the national clinical audit for adult general ICUs in England, Wales, and Northern Ireland.

PATIENTS

All adult patients 16 years old or older admitted to adult general ICUs contributing data to the Case Mix Programme Database between January 1, 1997, and December 31, 2016.

MEASUREMENTS AND MAIN RESULTS

The annual number, trends, and outcomes for patients across four age bands (16-64, 65-74, 75-84, and 85+ yr) admitted to ICUs contributing to the Case Mix Programme Database from 1997 to 2016 were examined. Case mix, activity, and outcome were described in detail for the most recent cohort of patients admitted in 2015-2016. Between 1997 to 2016, the annual number of admissions to ICU of patients in the older age bands increased disproportionately, with increases that could not be explained solely by general U.K. demographic shifts. The risk-adjusted acute hospital mortality decreased significantly within each age band over the 20-year period of the study. Although acute severity at ICU admission was comparable with that of the younger age group, apart from cardiovascular and renal dysfunction, older patients received less organ support. Older patients stayed longer in hospital post-ICU discharge, and hospital mortality increased with age, but the majority of patients surviving to hospital discharge returned home.

CONCLUSIONS

Over the past two decades, elderly patients have been more commonly admitted to ICU than can be explained solely by the demographic shift. Importantly, as with the wider population, outcomes in elderly patients admitted to ICU are improving over time, with most patients returning home.

Community-acquired pneumonia in critically ill very old patients: a growing problem

Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit.

There is currently no international recommendation for the management of critically ill older patients over 80 years of age with CAP. We report and discuss recent literature in order to help physicians in the decision-making process of these patients.http://bit.ly/2ql0mIz

Supporting the Geriatric Critical Care Patient: Decision Making, Understanding Outcomes, and the Role of Palliative Care

Geriatric admissions to the intensive care unit (ICU) are common and require unique considerations for ICU clinicians. Admission to the ICU should be considered on an individual-patient basis. It is reasonable to consider a "trial of critical care" for many patients, even those who have uncertain chances of meaningful recovery. Quality of life and functional independence are especially important to older adults, and these outcomes should be considered when weighing the risks and benefits of admission or continuing ICU care.

PES Pathogens in Severe Community-Acquired Pneumonia

Worldwide, there is growing concern about the burden of pneumonia. Severe community-acquired pneumonia (CAP) is frequently complicated by pulmonary and extra-pulmonary complications, including sepsis, septic shock, acute respiratory distress syndrome, and acute cardiac events, resulting in significantly increased intensive care admission rates and mortality rates. Streptococcus pneumoniae (Pneumococcus) remains the most common causative pathogen in CAP. However, several bacteria and respiratory viruses are responsible, and approximately 6% of cases are due to the so-called PES (Pseudomonas aeruginosa, extended-spectrum β-lactamase Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus) pathogens. Of these, P. aeruginosa and methicillin-resistant Staphylococcus aureus are the most frequently reported and require different antibiotic therapy to that for typical CAP. It is therefore important to recognize the risk factors for these pathogens to improve the outcomes in patients with CAP.

Caring for the critically ill patients over 80: a narrative review

Background

There is currently no international recommendation for the admission or treatment of the critically ill older patients over 80 years of age in the intensive care unit (ICU), and there is no valid prognostic severity score that includes specific geriatric assessments.

Main body

In this review, we report recent literature focusing on older critically ill patients in order to help physicians in the multiple-step decision-making process. It is unclear under what conditions older patients may benefit from ICU admission. Consequently, there is a wide variation in triage practices, treatment intensity levels, end-of-life practices, discharge practices and frequency of geriatrician’s involvement among institutions and clinicians. In this review, we discuss important steps in caring for critically ill older patients, from the triage to long-term outcome, with a focus on specific conditions in the very old patients.

Conclusion

According to previous considerations, we provide an algorithm presented as a guide to aid in the decision-making process for the caring of the critically ill older patients.

Electronic supplementary material

The online version of this article (10.1186/s13613-018-0458-7) contains supplementary material, which is available to authorized users.

Healthcare-related costs in very elderly intensive care patients

INTRODUCTION

The long-term outcome of "very old intensive care unit patients" (VOPs; ≥ 80 years) is often disappointing. Little is known about the healthcare costs of these VOPs in comparison to younger ICU patients and the very elderly in the general population not admitted to the ICU.

METHODS

Data from a national health insurance claims database and a national quality registry for ICUs were combined. Costs of VOPs admitted to the ICU in 2013 were compared with costs of younger ICU patients (two groups, respectively 18-65 and 65-80 years old) and a matched control group of very elderly subjects who were not admitted to the ICU. We compared median costs and median costs per day alive in the year before ICU admission (2012), the year of ICU admission (2013) and the year after ICU admission (2014).

RESULTS

A total of 9272 VOPs were included and compared to three equally sized study groups. Median costs for VOPs in 2012, 2013 and 2014 (€5944, €35,653 and €12,565) are higher compared to the ICU 18-65 population (€3022, €30,223 and €5052, all p < 0.001) and the very elderly control population (€3590, €4238 and €4723, all p < 0.001). Compared to the ICU 65-80 population, costs of VOPs are higher in the year before and after ICU admission (€4323 and €6750, both p < 0.001), but not in the year of ICU admission (€34,448, p = 0.950). The median healthcare costs per day alive in the year before, the year of and the year after ICU admission are all higher for VOPs than for the other groups (p < 0.001).

CONCLUSIONS

VOPs required more healthcare resources in the year before, the year of and the year after ICU admission compared to younger ICU patients and the very elderly control population, except compared to the ICU 65-80 population in the year of ICU admission. Healthcare costs per day alive, however, are substantially higher for VOPs than for all other study groups in all three studied years.

Outcome of older persons admitted to intensive care unit, mortality, prognosis factors, dependency scores and ability trajectory within 1 year: a prospective cohort study

BACKGROUND

The outcome and functional trajectory of older persons admitted to intensive care (ICU) unit remain a true question for critical care physicians and geriatricians, due to the heterogeneity of geriatric population, heterogeneity of practices and absence of guidelines.

AIM

To describe the 1-year outcome, prognosis factors and functional trajectory for older people admitted to ICU.

METHODS

In a prospective 1-year cohort study, all patients aged 75 years and over admitted to our ICU were included according to a global comprehensive geriatric assessment. Follow-up was conducted for 1 year survivors, in particular, ability scores and living conditions.

RESULTS

Of 188 patients included [aged 82.3 ± 4.7 years, 46% of admissions, median SAPS II 53.5 (43-74), ADL of Katz's score 4.2 ± 1.6, median Barthel's index 71 (55-90), AGGIR scale 4.5 ± 1.5], the ICU, hospital and 1-year mortality were, respectively, 34, 42.5 and 65.5%. Prognosis factors were: SAPS 2, mechanical ventilation, comorbidity (Lee's and Mc Cabe's scores), disability scores (ADL of Katz's score, Barthel's index and AGGIR scale), admission creatinin, hypoalbuminemia, malignant haemopathy, cognitive impairment. One-year survivors lived in their own home for 83%, with a preserved physical ability, without significant variation of the three ability assessed scores compared to prior ICU admission.

CONCLUSION

The mortality of older people admitted to ICU is high, with a significant impact of disabilty scores, and preserved 1-year survivor independency. Other studies, including a better comprehensive geriatric assessment, seem necessary to determine a predictive "phenotype" of survival with a "satisfactory" level of autonomy.

Inhospital outcome of elderly patients in an intensive care unit in a Sub-Saharan hospital

Background

In Burkina Faso, demographics are changing and we are seeing a growing prevalence of older patients in intensive care units. Elderly people have increased health care needs but there is a lack of geriatric specialists. This study aimed to analyze in-hospital outcome of patients aged over 65 years, admitted to the Intensive Care Unit (ICU) at Yalgado Hospital.

Methods

We carried out a 5-year retrospective study in the ICU of Yalgado Ouédraogo Hospital. Elderly patients with completed records were included. Baseline characteristics, clinical and outcome were analyzed.

Results

Two thousand one hundred sixteen patients were admitted to ICU, 237 (11.2%) of whom were included. There were 70 females and 167 males. The median age was 71.7 ± 6.1 years. The overall mortality rate in ICU was 73%, of whom 90% died within 7 days after admission. In multivariate analysis, shock (Odds Ratio: OR = 2.2, p = 0.002), severe brain trauma (OR; 9.6, p = 0.002), coma (OR 5.8 p < 0.003), surgical condition (OR = 4.2, p = 0.003), ASAPS Score ≥ 8 (OR = 4.3, p = 0.001), complication occurring (OR = 5.2_,p = 0.001) and stroke (OR = 3.7_,p = 0.001) were independent factors.

Conclusion

Elderly patients were frequent in ICU and their mortality rate was high. Stroke, severe brain trauma, surgery, complications occurring during hospitalization were independent risk factors of death.

Ten-year trends in intensive care admissions for respiratory infections in the elderly

BACKGROUND

The consequences of the ageing population concerning ICU hospitalisation need to be adequately described. We believe that this discussion should be disease specific. A focus on respiratory infections is of particular interest, because it is strongly associated with old age. Our objective was to assess trends in demographics over a decade among elderly patients admitted to the ICU for acute respiratory infections.

METHODS

A cross-sectional study was performed between 2006 and 2015 based on hospital discharge databases in one French region (2.5 million inhabitants). Patients with acute respiratory infection were selected according to the specific ICD-10 diagnosis codes recorded, including acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and community-acquired pneumonia (CAP). We also identified comorbid conditions based on any significant ICD-10 secondary diagnoses adapted from the Charlson and Elixhauser indexes.

RESULTS

A total of 98,381 hospital stays for acute respiratory infection were identified among the 3,856,785 stays over the 10-year period. The number of patients 75 y/o and younger increased 1.6-fold from 2006 to 2015, whereas the numbers of patients aged 85-89 and ≥ 90 y/o increased by 2.5- and 2.1-fold, respectively. Both CAP and AECOPD hospitalisations significantly increased for all age groups over the decade. ICU hospitalisations for respiratory infection increased 2.7-fold from 2006 to 2015 (p = 0.0002). The greatest increases in the use of ICU resources were for the 85-89 and ≥ 90 y/o groups, which corresponded to increases of 3.3- and 5.8-fold. Indeed, the proportion of patients hospitalized for respiratory infection in ICU that were elderly clearly grew during the decade: 11.3% were ≥ 85 y/o in 2006 versus 16.4% in 2015 (p < 0.0001). This increase in ICU hospitalisation rate of ageing patients was not associated with significant changes in the level of care or ICU mortality except for patients ≥ 90 y/o (for whom ICU mortality dropped from 40.9 to 22.3%, p = 0.03).

CONCLUSION

We observed a substantial increase in acute respiratory infection diagnoses associated with hospitalisation between 2006 and 2015, with a growing demand for critical care services. Both the absolute number and the percentage of elderly patient ICU admissions increased over the last decade, with the greatest increases being observed for patients 85 years and older.

Is mortality in elderly septic patients as high as expected? Long-term mortality in a surgical sample cohort

PURPOSE

To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival.

MATERIALS AND METHODS

A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records.

RESULTS

A total of 206 patients were included, divided into three groups of age (65-74, 75-85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65-74 years age group; 32.5%, 38.6% and 45.8% in the 75-85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction.

CONCLUSIONS

The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality.

Impact of mechanical ventilation on quality of life and functional status after ICU discharge: A cross-sectional study

OBJECTIVE

To evaluate the impact of the need for mechanical ventilation (MV) and its duration throughout ICU stay on the quality of life (QoL) and physical functional status (PFS) after the immediate ICU discharge.

METHOD

This was a cross-sectional study including all subjects consecutively discharged from the ICU during 1-year period. During the first week after ICU discharge, QoL was assessed through WHOQoL-Bref questionnaire and PFS through the Karnofsky Performance Status and modified-Barthel index, and retrospectively compared with the pre-admission status (variation [Δ] of indexes).

RESULTS

During the study, 160 subjects met the inclusion criteria. Subjects receiving MV presented PFS impairment (Δ Karnofsky Performance Status [-19.7 ± 20.0 vs. -14.9 ± 18.2; p=0.04] and Δ modified-Barthel index [-17.4 ± 12.8 vs. -13.2 ± 12.9; p=0.05]) compared with those who did not receive MV. Duration of MV was a good predictor of PFS (Δ Karnofsky Performance Status [-14.6-1.12 * total days of MV; p=0.01] and Δ modified-Barthel index [-14.2-0.74 * total days of MV; p=0.01]). QoL, assessed by WHOQoL-Bref, showed no difference between groups (14.0 ± 1.8 vs. 14.5 ± 1.9; p=0.14), and the duration of MV did not influence QoL (WHOQoL-Bref scale [14.2-0.05* total days of MV; p=0.43]).

CONCLUSION

Need for MV and duration of MV decrease patient PFS after ICU discharge.

How does prior health status (age, comorbidities and frailty) determine critical illness and outcome?

PURPOSE OF REVIEW

Critical illness has a significant impact on an individual's physical and mental health. However, it is less clear to what degree outcomes after critical illness are due to patients' preexisting characteristics, rather than the critical illness itself. In this review, we summarize recent findings regarding the role of age, comorbidity and frailty on long-term outcomes after critical illness.

RECENT FINDINGS

Age, comorbidity and frailty are all associated with an increased risk of critical illness. Although severity of illness drives the risk of acute mortality, recent data suggest that longer term outcomes are much more closely aligned with prior health status. There are growing data regarding the important role of noncardiovascular comorbidity, including psychiatric illness and obesity, in determining long-term outcomes. Finally, preadmission frailty is associated with poor long-term outcomes after critical illness; further data are needed to evaluate the attributable impact of critical illness on the health trajectories of frail individuals.

SUMMARY

Age, comorbidity and frailty play a critical role in determining the long-term outcomes of patients requiring intensive care.

Are we ever too old?: Characteristics and outcome of octogenarians admitted to a medical intensive care unit

The aging population increases the demand of intensive care unit (ICU) treatments. However, the availability of ICU beds is limited. Thus, ICU admission of octogenarians is considered controversial. The population above 80 years is a very heterogeneous group though, and age alone might not be the best predictor. Aim of this study was to analyze resource consumption and outcome of octogenarians admitted to a medical ICU to identify reliable survival predictors in a senescent society.This retrospective observational study analyzes 930 octogenarians and 5732 younger patients admitted to a medical ICU. Admission diagnosis, APACHE II and SAPS II scores, use of ICU resources, and mortality were recorded. Long-term mortality was analyzed using Kaplan-Meier survival curves and multivariate cox regression analysis.Patients ≥80 years old had higher SAPS II (43 vs 38, P < .001) and APACHE II (23 vs 21, P = .001) scores. Consumption of ICU resources by octogenarians was lower in terms of length of stay, mechanical ventilation, and renal replacement therapy. Among octogenarians, ICU survivors got less mechanical ventilation or renal replacement therapy than nonsurvivors. Intra-ICU mortality in the very old was higher (19% vs 12%, P < .001) and long-term survival was lower (HR 1.76, P < .001). Multivariate cox regression analysis of octogenarians revealed that admission diagnosis of myocardial infarction (HR 1.713, P = .023), age (1.08, P = .002), and SAPS II score (HR 1.02, 95%, P = .01) were independent risk factors, whereas admission diagnoses monitoring post coronary intervention (HR .253, P = .002) and cardiac arrhythmia (HR .534, P = .032) had a substantially reduced mortality risk.Octogenarians show a higher intra-ICU and long-term mortality than younger patients. Still, they show a considerable life expectancy after ICU admission even though they get less invasive care than younger patients. Furthermore, some admission diagnoses like myocardial infarction, cardiac arrhythmia and monitoring post cardiac intervention are much stronger predictors for long-term survival than age or SAPS II score in the very old.

The impact of intensive care in a private hospital on patients aged 80 and over: health-related quality of life, functional status and burden versus benefit

BACKGROUND

Greater numbers of persons aged over 80 years are admitted to intensive care units (ICU) compared with 15 years ago. Outcomes other than death such as physical dependence and cognitive impairment and treatment burden are important to older people.

AIMS

The aims of this study were to determine the long-term outcomes of functional impairment, health-related quality of life (HRQoL) and the self-reported burden of treatment in a sample of patients aged 80 years and above admitted to ICU. Half of the cohort were admitted for elective cardiac surgery, the rest for non-cardiac surgery and medical conditions.

METHODS

In this longitudinal cohort study, in a tertiary level ICU, we measured HRQoL using the SF-36 and functional status using the modified Barthel Index at several time points over a 2-year follow-up period. We also assessed treatment burden by asking participants whether they thought the episode of care was worthwhile.

RESULTS

A total of 348 patients was recruited into the study. One-fifth of the cohort had died by the 2-year follow-up data collection point. There was an improvement in physical functioning in the cardiac surgery group at 6 months which was not sustained. There was no change in HRQoL at 2 years in either group. The majority valued the episode of care.

CONCLUSION

We demonstrated that HRQoL and previous lifestyle is preserved in the majority following ICU admission, associated with a high level of patient valuation of the episode of care.

Predicting Performance Status 1 Year After Critical Illness in Patients 80 Years or Older: Development of a Multivariable Clinical Prediction Model

OBJECTIVE

We sought to develop and internally validate a clinical prediction model to estimate the outcome of very elderly patients 12 months after being admitted to the ICU.

DESIGN

Prospective, longitudinal cohort study.

SETTING

Twenty-two Canadian ICUs.

PATIENTS

We recruited 527 patients 80 years or older who had a medical or urgent surgical diagnosis and were admitted to an ICU for at least 24 hours.

MEASUREMENTS AND MAIN RESULTS

At baseline, we completed a comprehensive geriatric assessment of enrolled patients; survival and functional status was determined 12 months later. We defined recovery from critical illness as Palliative Performance Scale score of greater than or equal to 60. We used logistic regression analysis to examine factors associated with this outcome. Of the 434 patients (82%) whose Palliative Performance Scale was known at 12 months, 50% had died and 29% (126/434) had a score of greater than or equal to 60. In the multivariable model, we found that being married, having a primary diagnosis of emergency coronary artery bypass grafting or valve replacement, and higher baseline Palliative Performance Scale were independently predictive of a 12-month Palliative Performance Scale score of greater than or equal to 60. Male sex, primary diagnosis of stroke, and higher Acute Physiology and Chronic Health Evaluation II score, Charlson comorbidity index, or clinical frailty scale were independently predictive of Palliative Performance Scale score of less than 60.

CONCLUSION

Approximately one-quarter of very old ICU patients achieve a reasonable level of function 1 year after admission. This prediction model applied to individual patients may be helpful in decision making about the utility of life support for very elderly patients who are admitted to the ICU.

[Elderly patients and intensive care: Systematic review and geriatrician's point of view]

The global population is aging and intensive care unit admission rate of elderly patients is dramatically increasing. The objective of this review is to provide an overview of the literature about the management of elderly patients in intensive care unit and more specifically about epidemiology, admission criteria, mortality, functional prognosis and ethical aspects. We also discuss the data on cardiorespiratory arrest, shock, acute respiratory failure and delirium. The mortality rate of patients over 80 years old in intensive care unit can reach up to 70% at 1year, but is dependent on many factors, such as comorbidities or frailty. Above all, more than half of elderly patients recover their long-term autonomy. Their quality of life is comparable to that of the same age population. Considering that the first 3months after an intensive care unit stay are the most decisive in terms of vital and functional prognosis, we will discuss strategies to improve care through the creation of dedicated intensive care-geriatrics networks.

Functional Status and Quality of Life in Elderly Intensive Care Unit Survivors

OBJECTIVES

To evaluate functional status and quality of life in elderly intensive care unit (ICU) survivors at 1-year follow-up.

DESIGN

Prospective 18-month observational study.

SETTING

University medical-surgical ICU.

PARTICIPANTS

ICU survivors aged 75 and older.

MEASUREMENTS

Functional status at baseline (Barthel Index (BI)) was compared with that at hospital discharge and 1-year follow-up. Health-related quality of life (HRQL Spanish version of the Medical Outcomes Study 36-item Short-From Survey) was measured at 1-year follow-up and compared with that of the Spanish population of same age.

RESULTS

Of 176 individuals admitted to the ICU, 110 (62.1%) were discharged alive from the hospital, and 94 (53.1%) were alive at 1-year follow-up. ICU admission was associated with significant clinical deterioration (median BI 100 points (interquartile range (IQR) 85-100) at baseline vs 85 (IQR 60-100) at hospital discharge, P < .001). Three months after discharge, there was a significant although modest improvement in functional status (BI 95 (IQR 80-100) P = .03). Baseline functional status was not recovered at 1-year follow-up (BI 95 (IQR 80-100) P < .001). More ICU survivors had moderate to severe dependence at the end of follow-up (20.3%) than at ICU admission (6.6%) (P < .001). Factors independently associated with poor functional recovery were low baseline BI and ICU stay longer than 4 days. At 1-year follow-up, 76.8% of participants who survived were living in their own homes. HRQL was similar to that of the Spanish population of the same age.

CONCLUSION

Elderly ICU survivors experienced significant deterioration in functional status, and although they recovered modestly during the following year, they never regained their baseline status. Good recovery was associated with short ICU stay and better baseline functional status.

Assessing the utility of ICU admission for octogenarians

BACKGROUND

Advanced age is associated with increased severity of acute critical illnesses and admission to ICU. Despite advances in the support for older critically ill patients, the short- and long-term mortality rates remain substantial. The purpose of this study is to analyze the factors influencing the outcome of a geriatric population admitted to the ICU.

METHODS

A single-center, prospective, observational study was conducted among all geriatric patients, 80 years or older, admitted to ICU during a 6-month study period.

RESULTS

Fifty-two patients were admitted. Mean age was 85.1 years (range 80-96), mean APACHE-II score was 24.7 (range 11-40), and mean frailty score was 5.8 (range 3-8). Thirty-nine (75 %) patients received mechanical ventilation, and 31 (59.7 %) were on vasoactive therapy. Twenty-four (46.3 %) patients died during their hospital admission, and 13 (25 %) of them expired in ICU.

DISCUSSION

Advanced age, needs for vasopressor therapy, and mechanical ventilation are independent predictive factors of adverse outcome. Pre-admission functional status was not independently associated with unfavorable outcome.

Elderly patients hospitalized in the ICU in France: a population-based study using secondary data from the national hospital discharge database

RATIONALE, AIMS AND OBJECTIVES

In the global context of population ageing, understanding and monitoring intensive care use by the elderly is a strategic issue. National-level data are needed to overcome sampling biases that often limit epidemiologic studies of the critically ill elderly. The objective of this study was to describe intensive care use for hospitalized elderly patients using secondary data from the French national hospital discharge database.

METHOD

Structured assessment of the national database coverage and accuracy; cross-sectional analysis of hospitalizations including at least one admission in an intensive care unit (ICU) for patients aged ≥ 80 years from 1 January to 31 December 2009.

RESULTS

In 2009, people aged ≥ 80 years accounted for 5.4% of the population but 15.3% of the 215 210 adult hospitalizations involving intensive care in France. In this elderly group, the mean age was 84.0 (± 3.56) years, and 51.6% were male. In-hospital mortality was 33.9%. The median time spent in the ICU was 3 [interquartile range (IQR), 2-8] days, the median time spent in hospital was 14 (IQR, 8-24) days and 9% of hospitalizations ended by the patient's death involved intensive care. A surgical procedure was included in 43% of hospitalizations. Medical and surgical diagnosis-related group hospitalizations were characterized by significant differences in volume, mortality, ICU days and costs.

CONCLUSIONS

There was marked clinical heterogeneity in the population of elderly patients hospitalized in the ICU. These data provide baseline information and prompt further studies comparing intensive care utilization across age groups, between countries and over time.

Treatment intensity and outcome of nonagenarians selected for admission in ICUs: a multicenter study of the Outcomerea Research Group

Background

Outcome of very elderly patients admitted in intensive care unit (ICU) was most often reported for octogenarians. ICU admission demands for nonagenarians are increasing. The primary objective was to compare outcome and intensity of treatment of octogenarians and nonagenarians.

Methods

We performed an observational study in 12 ICUs of the Outcomerea™ network which prospectively upload data into the Outcomerea™ database. Patients >90 years old (case patients) were matched with patients 80–90 years old (control patients). Matching criteria were severity of illness at admission, center, and year of admission.

Results

A total of 2419 patients aged 80 or older and admitted from September 1997 to September 2013 were included. Among them, 179 (7.9 %) were >90 years old. Matching was performed for 176 nonagenarian patients. Compared with control patients, case patients were more often hospitalized for unscheduled surgery [54 (30.7 %) vs. 42 (23.9 %), p < 0.01] and had less often arterial monitoring for blood pressure [37 (21 %) vs. 53 (30.1 %), p = 0.04] and renal replacement therapy [5 (2.8 %) vs. 14 (8 %), p = 0.05] than control patients. ICU [44 (25 %) vs. 36 (20.5 %), p = 0.28] or hospital mortality [70 (39.8 %) vs. 64 (36.4 %), p = 0.46] and limitation of life-sustaining therapies were not significantly different in case versus control patients, respectively. Only 16/176 (14 %) of case patients were transferred to a geriatric unit.

Conclusion

This multicenter study reported that nonagenarians represented a small fraction of ICU patients. When admitted, these highly selected patients received similar life-sustaining treatments, except RRT, than octogenarians. ICU and hospital mortality were similar between the two groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s13613-016-0133-9) contains supplementary material, which is available to authorized users.

Mortality and functional status at one-year of follow-up in elderly patients with prolonged ICU stay

OBJECTIVE

To evaluate mortality and functional status at one year of follow-up in patients>75 years of age who survive Intensive Care Unit (ICU) admission of over 14 days.

DESIGN

A prospective observational study was carried out.

SETTING

A Spanish medical-surgical ICU.

PATIENTS

Patients over 75 years of age admitted to the ICU.

PRIMARY VARIABLES OF INTEREST

ICU admission: demographic data, baseline functional status (Barthel index), baseline mental status (Red Cross scale of mental incapacity), severity of illness (APACHE II and SOFA), stay and mortality. One-year follow-up: hospital stay and mortality, functional and mental status, and one-year follow-up mortality.

RESULTS

A total of 176 patients were included, of which 22 had a stay of over 14 days. Patients with prolonged stay did not show more ICU mortality than those with a shorter stay in the ICU (40.9% vs 25.3% respectively, P=.12), although their hospital (63.6% vs 33.8%, P<.01) and one-year follow-up mortality were higher (68.2% vs 41.2%, P=.02). Among the survivors, one-year mortality proved similar (87.5% vs 90.6%, P=.57). These patients presented significantly greater impairment of functional status at hospital discharge than the patients with a shorter ICU stay, and this difference persisted after three months. The levels of independence at one-year follow-up were never similar to baseline. No such findings were observed in relation to mental status.

CONCLUSIONS

Patients over 75 years of age with a ICU stay of more than 14 days have high hospital and one-year follow-up mortality. Patients who survive to hospital admission did not show greater mortality, though their functional dependency was greater.

Clinical characteristics and outcome of very elderly patients ≥90 years in intensive care: a retrospective observational study

Background

Since the overall prognosis of very elderly patients is generally limited, admissions to intensive care in these patients are often restricted. Therefore, only very few information is available on the prognosis of nonagenarians after intensive care treatment. The aim of this study was to analyze the clinical characteristics and outcomes of very elderly patients (≥90 years) admitted to an intensive care unit (ICU).

Methods

Monocentric, retrospective observational study of all patients aged ≥90 years admitted to the Department of Intensive Care Medicine with a total capacity of 132 ICU beds at the University Medical Center Hamburg in Germany between January 2008 and June 2013. A multivariate Cox regression analysis was used to identify risk factors for 28-day outcome.

Results

A total of 372 patients ≥90 years of age were admitted to one of the departments ICUs. The majority of patients (66.7 %) were admitted as an emergency admission, of which half underwent unscheduled surgery. 39.8 % of patients required support by mechanical ventilation and vasoactive drugs, and 1.9 % of patients received renal replacement. ICU and hospital mortality rates were 18.3 and 30.9 %, respectively. Overall survival at 1 year after hospital discharge was 34.9 %. Multivariate Cox regression analysis revealed creatinine, bilirubin, age, and necessity of catecholamines as independent risk factors and scheduled surgery as protective factor for 28-day outcome.

Conclusion

Nearly 70 % of patients aged ≥90 years were discharged alive from hospital following treatment at the ICU, and more than half of them were still alive 1 year after their discharge. The results suggest that 1-year survival prognosis of very old ICU patients is not as poor as often perceived and that age per se should not be an exclusion criterion for ICU admission.

Trial registration: WF-0561/13

Hospital mortality in postoperative critically ill patients older than 80 years. Can we predict it at an early stage?

OBJECTIVES

To determine the incidence of in-hospital mortality throughout the post-surgical period of patients aged 80 or over who were admitted to the post-surgical critical care unit, as well as to assess the predictive capacity of those variables existing in the first 48hours on the in-hospital mortality.

MATERIAL AND METHODS

An observational retrospective cohort study conducted on postsurgical patients up to 80years old who were admitted to the unit between June 2011 and December 2013. Univariate and multivariate binary logistic regression was used to determine the association between mortality and the independent variables.

RESULTS

Of the 186 patients included, 9 (4.8%) died in the critical care unit, and 22 (11.8%) died in wards during hospital admission, giving a hospital mortality of 31 (16.7%). Among the 78 patients (42%) that underwent acute surgery, and the 108 who underwent elective surgery, there was a mortality rate of 19 (10.2%) and 12 (6.5%), respectively. As regards the variables analysed during the first 48hours of admission that showed to be hospital mortality risk factor were the need for mechanical ventilation over 48h, with an OR: 7.146 (95%CI: 1.563-32.664, P=.011) and the degree of the severity score on the APACHE II scale in the first 24hours, with an OR: 1.102 (95%CI: 1.005-1.208, P=.039).

CONCLUSION

The incidence of hospital mortality in very old patients found in our study is comparable to that reported by other authors. Patients who need mechanical ventilation over 48h, and with higher scores in the APACHE II scale could be at a higher risk of in-hospital mortality.

Trends in hospital and intensive care admissions in the Netherlands attributable to the very elderly in an ageing population

Introduction

The Dutch population is ageing and it is unknown how this is affecting trends in the percentage of hospital and intensive care unit (ICU) admissions attributable to patients aged 80 years or older, the very elderly.

Methods

We present data on the percentage of the very elderly in the general population and the percentage of hospital admissions attributable to the very elderly. We subsequently performed a longitudinal cross-sectional study on ICU admissions from hospitals participating in the National Intensive Care Evaluation registry for the period 2005 to 2014. We modeled the percentage of adult ICU admissions and treatment days attributable to the very elderly separately for ICU admissions following cardiac surgery and other reasons.

Results

The percentage of Dutch adults aged 80 years and older, increased from 4.5 % in 2005 to 5.4 % in 2014 (p-value < 0.0001) and with this ageing of the population, the percentage of hospital admissions attributable to very elderly increased from 9.0 % in 2005 to 10.6 % in 2014 (p-value < 0.0001). The percentage of ICU admissions following cardiac surgery attributable to the very elderly increased from 6.7 % in 2005 to 11.0 % in 2014 in nine hospitals (p-value < 0.0001), while the percentage of treatment days attributable to this group rose from 8.6 % in 2005 to 11.7 % in 2014 (p-value = 0.0157). In contrast, the percentage of very elderly patients admitted to the ICU for other reasons than following cardiac surgery remained stable at 13.8 % between 2005 and 2014 in 33 hospitals (p-value = 0.1315). The number of treatment days attributable to the very elderly rose from 11,810 in 2005 to 15,234 in 2014 (p-value = 0.0002), but the percentage of ICU treatment days attributable to this group remained stable at 12.0 % (p-value = 0.1429).

Conclusions

As in many European countries the Dutch population is ageing and the percentage of hospital admissions attributable to the very elderly rose between 2005 and 2014. However, the percentage of ICU admissions and treatment days attributable to very elderly remained stable. The percentage of ICU admissions following cardiac surgery attributable to this group increased between 2005 and 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-1061-z) contains supplementary material, which is available to authorized users.