Outcome of older persons admitted to intensive care unit, mortality, prognosis factors, dependency scores and ability trajectory within 1 year: a prospective cohort study
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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.
To describe the 1-year outcome, prognosis factors and functional trajectory for older people admitted to ICU.
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.
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.
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.
KeywordsOlder persons Intensive care unit Survival Ability and ADL scores Comprehensive geriatric assessment Ethics
Nursing and care staff, in particular Geraud Lesoin, Jérôme Boué and Corinne Bonnet, who know the reality of older people admitted to ICU. Marianne Gabbani, Sylvie Schooberg, Bernard Morteau, and Jean Loup Galiacy, for your friendly medical and ethical reflection. Pr Isabelle Bourdel-Marchasson and Pr Muriel Rainfray, for their experience, teaching and medical humanities. Béatrice and Alice for your sorority, assistance and second reading of the manuscript. Guillaume and Jean Sebastien, and brothers in arms. Sylvie, Hanna, Rebecca, Elie, Myriam and Deborah, for help and patience.
Compliance with ethical standards
The complete medical care was supported by the public hospital of Agen, without any other source of funding, including study design, analysis, and writing of the manuscript.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
The study is observational and all the procedures were included in our protocols of usual care, in accordance with the ethical standards of the institutional research committee and the 1964 Helsinski declaration and its later amendments or comparable ethical standards.
The confidentiality and medical secret was also fully respected with individual and family informed consent. Consent for this study was also given by the hospital management director, as well as the People Protection and Ethics Committee of the district.
- 7.De Rooj S, Govers AC, Korevvar JC et al (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. https://doi.org/10.1111/j.1532-5415.2008.01671.x CrossRefGoogle Scholar
- 8.Ferrante LE, Pisani MA, Murphy TE et al (2015) Functional trajectories among older persons before and after critical illness. JAMA 175:523–529Google Scholar
- 12.Vargas N, Tibullo l, Landi E et al.Caring for critically oldest old patients: a clinical review. Aging Clin Exp Res. https://doi.org/10.1007/s40520-016-0638-y
- 14.Garrouste-Orgeas M, Boumendil A, Pateron D et al (2009) Selection of ICU admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: an observational, multicenter, prospective study. Crit Care Med 37:2919–2928CrossRefPubMedGoogle Scholar
- 26.Scala R (2016) Challenges of non-invasive ventilation to treat acute respiratory failure in the elderly. BMC Pulm Med 16:150. https://doi.org/10.1186/s12890-016-0310-5
- 32.Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Med State Med J 14:61–65Google Scholar