Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study
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Increasingly, very old patients are admitted to Intensive Care Units (ICUs). The objective of this study was to describe 12-month outcomes of these patients and determine which characteristics are associated with a return to baseline physical function 1 year later.
In this prospective cohort study in 22 Canadian hospitals, we recruited 610 patients aged 80 years or older who were admitted to ICU for at least 24 h. At baseline, we completed a comprehensive geriatric assessment and followed patients to determine 12-month survival and physical function. Our primary outcome was physical recovery from critical illness at 12 months, defined as being alive with Short Form-36 physical function score of at least 10 points, and not 10 or more points below baseline. We used regression analysis to examine factors associated with physical recovery.
Patients were on average 84 years old (range 80–99). Mortality was 14 % in ICU, 26 % in hospital and 44 % at 12 months after admission. Of 505 patients evaluable at 12 months, 26 % achieved physical recovery. In the multivariable model, physical recovery was significantly associated with younger age, lower APACHE II score, lower Charlson comorbidity score, lower frailty index, lower baseline physical function score, and specific admission diagnoses.
One-quarter of patients aged 80 years or older who are admitted to ICU survived and returned to baseline levels of physical function at 1 year. Routine assessment of baseline physical function and frailty status could aid in prognostication and informed decision-making for very old critically ill patients. (ClinicalTrials.gov number NCT01293708).
KeywordsOutcome assessment Critical illness Physical function Follow up study Frailty Aged 80 and older
Funded by the Canadian Institutes of Health Research.
Compliance with ethical standards
Conflicts of interest
The protocol was endorsed and conducted in collaboration with the Canadian Critical Care Trials Group (www.ccctg.ca) and the Canadian Researchers at the End of Life Network (www.thecarenet.ca). The study was funded by the Canadian Institutes of Health Research which played no role in the design, conduct, analysis, interpretation of results or decision to publish. Dr Heyland and Mr. Day have had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Dr. Cook is a Canada Research Chair of the Canadian Institutes of Health Research. Kenneth Rockwood is supported by the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research. Dr. Turgeon is a Clinician Scientist of the Fonds de Recherche du Québec-Santé (FRQ-S). Dr. Bagshaw holds a Canada Research Chair in Critical Care Nephrology and is supported by a Clinical Investigator Award from Alberta Innovates-Health Solutions (AI-HS). Dr. Fowler is a Clinician Scientist of the Heart and Stroke Foundation (Ontario). Dr Burns holds a CIHR Clinician Scientist Award and a Ministry of Research and Innovation Early Researcher Award. No investigators report financial or other conflicts of interest.
- 12.de Rooij SE, Govers AC, Korevaar JC, Giesbers AW, Levi M, de Jonge E (2008) Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc 56:816–822. doi: 10.1111/j.1532-5415.2008.01671.x CrossRefPubMedGoogle Scholar
- 20.Sacanella E, Pérez-Castejón JM, Nicolás JM, Masanés F, Navarro M, Castro P, López-Soto A (2011) Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study. Crit Care 15:R105. doi: 10.1186/cc10121 PubMedCentralCrossRefPubMedGoogle Scholar
- 21.Khouli H, Astua A, Dombrowski W, Ahmad F, Homel P, Shapiro J, Singh J, Nallamothu R, Mahbub H, Eden E, Delfiner J (2011) Changes in health-related quality of life and factors predicting long-term outcomes in older adults admitted to intensive care units. Crit Care Med 39:731–737. doi: 10.1097/CCM.0b013e318208edf8 CrossRefPubMedGoogle Scholar
- 23.Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, Tayler C, Porterfield P, Sinuff T, Simon J, ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team; Canadian Researchers at the End of Life Network (CARENET) (2013) Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med 173:778–787. doi: 10.1001/jamainternmed.2013.180 CrossRefPubMedGoogle Scholar
- 24.Garrouste-Orgeas M, Tabah A, Vesin A, Philippart F, Kpodji A, Bruel C, Grégoire C, Max A, Timsit JF, Misset B (2013) The ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over. Intensive Care Med 39:1574–1583. doi: 10.1007/s00134-013-2977-x CrossRefPubMedGoogle Scholar
- 25.Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, Davido A, Masmoudi R, Doumenc B, Pateron D, Garrouste-Orgeas M, Somme D, Simon T, Aegerter P, Guidet B, ICE-CUB study group (2012) Variability of intensive care admission decisions for the very elderly. PLoS ONE 7:e34387. doi: 10.1371/journal.pone.0034387 PubMedCentralCrossRefPubMedGoogle Scholar
- 27.Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300:1665–1673. doi: 10.1001/jama.300.14.1665 PubMedCentralCrossRefPubMedGoogle Scholar
- 28.Goldstein J, Hubbard RE, Moorhouse P, Andrew MK, Mitnitski A, Rockwood K (2015) The validation of a care partner-derived frailty index based upon comprehensive geriatric assessment (CP-FI-CGA) in emergency medical services and geriatric ambulatory care. Age Ageing 44:327–330. doi: 10.1093/ageing/afu161 CrossRefPubMedGoogle Scholar
- 31.Ware JE (1996) The SF-36 health survey. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials, 2nd edn. Lippincott-Raven, Philadelphia, pp 337–345Google Scholar
- 33.Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, Joseph L, Brown JP, Murray TM, Murray TM, Adachi JD, Hanley DA, Papadimitropoulos E, The Canadian Multicentre Osteoporosis Study Research Group (2000) Canadian normative data for the SF-36 health survey. CMAJ 163:265–271PubMedCentralPubMedGoogle Scholar
- 37.SAS Institute Inc (2014) SAS/STAT® 13.2 User’s Guide. SAS Institute, CaryGoogle Scholar
- 38.Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, Majumdar SR (2014) Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 186:E95–E102. doi: 10.1503/cmaj.130639 PubMedCentralCrossRefPubMedGoogle Scholar
- 39.Le Maguet P, Roquilly A, Lasocki S, Asehnoune K, Carise E, Saint Martin M, Mimoz O, Le Gac G, Somme D, Cattenoz C, Feuillet F, Malledant Y, Seguin P (2014) Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med 40:674–682. doi: 10.1007/s00134-014-3253-4 PubMedGoogle Scholar
- 41.Taneja S, Rutenberg A, Mitnitski A, Rockwood K (2014) A dynamical network model for frailty-induced mortality. Bull Am Phys Soc 59(1):J11–J17Google Scholar
- 44.Turnbull AE, Krall JR, Ruhl AP, Curtis JR, Halpern SD, Lau BM, Needham DM (2014) A scenario-based, randomized trial of patient values and functional prognosis on intensivist intent to discuss withdrawing life support. Crit Care Med 42:1455–1462. doi: 10.1097/CCM.0000000000000227 PubMedCentralCrossRefPubMedGoogle Scholar