Intensive Care Medicine

, Volume 41, Issue 11, pp 1911–1920 | Cite as

Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study

  • Daren K. Heyland
  • Allan Garland
  • Sean M. Bagshaw
  • Deborah Cook
  • Kenneth Rockwood
  • Henry T. Stelfox
  • Peter Dodek
  • Robert A. Fowler
  • Alexis F. Turgeon
  • Karen Burns
  • John Muscedere
  • Jim Kutsogiannis
  • Martin Albert
  • Sangeeta Mehta
  • Xuran Jiang
  • Andrew G. Day
Original

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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).

Keywords

Outcome assessment Critical illness Physical function Follow up study Frailty Aged 80 and older 

Supplementary material

134_2015_4028_MOESM1_ESM.docx (109 kb)
Supplementary material 1 (DOCX 109 kb)
134_2015_4028_MOESM2_ESM.docx (243 kb)
Supplementary material 2 (DOCX 243 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Daren K. Heyland
    • 1
  • Allan Garland
    • 2
  • Sean M. Bagshaw
    • 3
  • Deborah Cook
    • 4
  • Kenneth Rockwood
    • 5
  • Henry T. Stelfox
    • 6
  • Peter Dodek
    • 7
  • Robert A. Fowler
    • 8
  • Alexis F. Turgeon
    • 9
  • Karen Burns
    • 10
  • John Muscedere
    • 11
  • Jim Kutsogiannis
    • 12
  • Martin Albert
    • 13
  • Sangeeta Mehta
    • 14
  • Xuran Jiang
    • 1
  • Andrew G. Day
    • 1
  1. 1.Clinical Evaluation Research UnitKingston General HospitalKingstonCanada
  2. 2.Department of Medicine and Community Health SciencesUniversity of ManitobaWinnipegCanada
  3. 3.Division of Critical Care Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  4. 4.Departments of Medicine, Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  5. 5.Division of Geriatric MedicineDalhousie UniversityHalifaxCanada
  6. 6.Department of Critical Care Medicine, Institute for Public HealthUniversity of CalgaryCalgaryCanada
  7. 7.Division of Critical Care Medicine and Center for Health Evaluation and Outcome SciencesSt. Paul’s Hospital and University of British ColumbiaVancouverCanada
  8. 8.Interdepartmental Division of Critical Care Medicine, Sunnybrook HospitalUniversity of TorontoTorontoCanada
  9. 9.Division of Critical Care Medicine and Population Health and Optimal Health Practices Research UnitCentre Hospitalier Universitaire (CHU) de Québec and Université LavalQuebecCanada
  10. 10.Interdepartment Division of Critical CareUniversity of Toronto and St Michael’s HospitalTorontoCanada
  11. 11.Critical Care ProgramQueens University KingstonKingstonCanada
  12. 12.Division of Critical Care Medicine, Faculty of Medicine and DentistryThe University of AlbertaEdmontonCanada
  13. 13.Département de Médecine, Centre de recherche de l’Hôpital du Sacré-Coeur de MontréalUniversité de MontréalMontrealCanada
  14. 14.Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai HospitalUniversity of TorontoTorontoCanada

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