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Development of demographics and outcome of very old critically ill patients admitted to intensive care units

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To evaluate the development of demographics and outcome of very old (>80 years) critically ill patients admitted to intensive care units.


All consecutive patients admitted to 41 Austrian intensive care units (ICUs) over an 11-year period.


We performed a retrospective cohort study of prospectively collected data. To compare parameters over time, patients were divided into three groups (group I from 1998 until 2001, group II from 2002 to 2004, and group III from 2005 to 2008).


A total of 17,126 patients older than 80 years of age were admitted over the study period. The proportion of very old patients increased from 11.5% (I) to 15.3% (III) with a significant higher prevalence of females in all groups (on average 63.2%). Severity of illness also increased over time, even when corrected for age. Use of noninvasive mechanical ventilation increased over the years. However, risk-adjusted mortality rates [observed-to-expected (O/E) ratios] decreased from 1.14 [confidence interval (CI) 1.11–1.18] to 1.02 (CI 0.99–1.05). This improvement in outcome was confirmed on multivariate analysis: for every year delay in ICU admission, the odds to die decreased by 3%. Moreover, females exhibited a better outcome compared with males.


The relative and absolute numbers of very old patients increased over the study period, as did the severity of illness. Despite this, risk-adjusted hospital mortality improved over the study period. Females dominated in the very old patients and exhibited moreover a better outcome compared with males.

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  1. Department of Economic and Social Affairs: World population ageing 2009. United Nations, New York. Accessed 26 April 2011

  2. Bongaarts J (2009) Human population growth and the demographic transition. Phil Trans R Soc B 364:2985–2990

    Article  PubMed  Google Scholar 

  3. Lutz W, Sanderson W, Scherbov S (2008) The coming acceleration of global population ageing. Nature 451:716–719

    Article  PubMed  CAS  Google Scholar 

  4. Rosenthal GE, Kaboli PJ, Barnett MJ, Sirio CA (2002) Age and the risk of in-hospital death: insights from a multihospital study of intensive care patients. J Am Geriatr Soc 50:1205–1212

    Article  PubMed  Google Scholar 

  5. Creditor MC (1993) Hazards of hospitalization of the elderly. Ann Intern Med 118:219–222

    PubMed  CAS  Google Scholar 

  6. Bagshaw SM, Webb SAR, Delaney A, George C, Pilcher D, Hart GK, Bellomo R (2009) Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 13:R45

    Article  PubMed  Google Scholar 

  7. Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29:2137–2143

    Article  PubMed  Google Scholar 

  8. Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B (2007) Should elderly patients be admitted to the intensive care unit? Intensive Care Med 33:1252–1262

    Article  PubMed  Google Scholar 

  9. Nguyen YL, Angus DC, Boumendil A, Guidet B (2011) The challenge of admitting the very elderly to intensive care. Ann Intensive Care 1:29

    Article  PubMed  Google Scholar 

  10. Metnitz PhGH, Vesely H, Valentin A, Popow C, Hiesmayr M, Lenz K, Krenn CG, Steltzer H (1999) Evaluation of an interdisciplinary data set for national ICU assessment. Crit Care Med 27:1486–1491

    Article  PubMed  CAS  Google Scholar 

  11. Metnitz PhGH, Steltzer H, Popow C, Valentin A, Lenz K, Neumark J, Sagmüller G, Schwameis F, Urschitz M, Hiesmayr M (1997) Definition and evaluation of a documentation standard for intensive care medicine: the ASDI pilot project. Wien Klin Wochenschr 109:132–138

    PubMed  CAS  Google Scholar 

  12. Le Gall JR, Lemeshow St, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  PubMed  Google Scholar 

  13. Miranda DR, De Rijk A, Schaufeli W (1996) Simplified therapeutic interventions scoring system: the TISS-28 items—results from a multicenter study. Crit Care Med 4:64–73

    Article  Google Scholar 

  14. Metnitz PhGH, Krenn CG, Steltzer H, Lang Th, Ploder J, Lenz K, Le Gall JR, Druml W (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058

    Article  PubMed  Google Scholar 

  15. Hosmer DW, Lemeshow S (1995) Confidence interval estimates of an index of quality performance based on logistic regression models. Stat Med 14:2161–2172

    Article  PubMed  CAS  Google Scholar 

  16. Bauer P, Poetscher BM, Hackl P (1988) Model selection by multiple test procedures. Statistics 19:39–44

    Article  Google Scholar 

  17. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J (2000) Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease. JAMA 284:2762–2770

    Article  PubMed  CAS  Google Scholar 

  18. Statistik Austria, Bundesanstalt Statistik Österreich, A 1110 Vienna. Accessed 26 April 2011

  19. Garrouste-Orgeas M, Timsit JF, Montuclard L, Colvez A, Gattoliat O, Philippart F, Rigal G, Misset B, Carlet J (2006) Decision-making progress, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med 32:1045–1051

    Article  PubMed  Google Scholar 

  20. Hamel MB, Teno JM, Goldmann L, Lynn J, Davis RB, Galanos AN, Desbiens N, Connors AF, Wenger N, Phillips RS (1999) Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. Ann Intern Med 130:116–125

    PubMed  CAS  Google Scholar 

  21. Garrouste-Orgeas M, Boumendil A, Pateron D, Aergerter P, Somme D, Simon T, Guidet B, ICE-CUB Group (2009) Selection of intensive care unit 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 37:2919–2928

    Article  PubMed  Google Scholar 

  22. Boumendil A, Aegerter P, Guidet B, the CUB-Rea Network (2005) Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc 53:88–93

    Article  PubMed  Google Scholar 

  23. Lerolle N, Trinquart L, Bornstain C, Tadié JM, Imbert A, Diehl JL, Fagon JY, Guérot E (2010) Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med 38:59–64

    Article  PubMed  Google Scholar 

  24. Needham DM, Bronskill SE, Calinawan JR, Sibbald WJ, Pronovost PJ, Laupacis A (2005) Projected incidence of mechanical ventilation in Ontario to 2026: preparing for the aging baby boomers. Crit Care Med 33:574–579

    Article  PubMed  Google Scholar 

  25. Van Den Noorgate N, Vogelaers D, Afschrift M, Colardyn F (1999) Intensive care for elderly patients: outcome and risk factors for in-hospital mortality. Age Ageing 28:253–256

    Article  Google Scholar 

  26. Nin N, Lorente JA, Paula M, Fernandez Segoviano P, Penuelas O, Sanchez Ferrer A, Martinez Caro L, Esteban A (2008) Ageing increases the susceptibility to injurious mechanical ventilation. Intensive Care Med 34:923–931

    Article  PubMed  Google Scholar 

  27. Behrendt CE (2000) Acute respiratory failure in the United States: Incidence and 31-day survival. Chest 118:1100–1105

    Article  PubMed  CAS  Google Scholar 

  28. Ely EW, Wheeler AP, Thompson BT, Ancukiewicz M, Steinberg KP, Bernard GR (2002) Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome. Ann Intern Med 136:25–36

    PubMed  Google Scholar 

  29. Evans TW (2001) International consensus conferences in intensive care medicine: non-invasive positive pressure ventilation in acute respiratory failure. Intensive Care Med 27:166–178

    Article  PubMed  CAS  Google Scholar 

  30. Demoule A, Girou E, Richard JC, Taillé S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755

    Article  PubMed  Google Scholar 

  31. Nava S, Grassi M, Fanfulla F, Domenighetti G, Carlucci A, Perren A, Dell’orso D, Vitacca M, Ceriana P, Karakurt Z, Clini E (2011) Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomized controlled trial. Age Ageing 40:444–450

    Article  PubMed  Google Scholar 

  32. Nicolas F, Le Gall JR, Alperovitch A, Loirat P, Villers D (1987) Influence of patients’ age on survival, level of therapy and length of stay in intensive care units. Intensive Care Med 13:9–13

    Article  PubMed  CAS  Google Scholar 

  33. Goldhill DR, Sumner A (1998) Outcome of intensive care patients in a group of British intensive care units. Crit Care Med 26:1337–1345

    Article  PubMed  CAS  Google Scholar 

  34. Oeppen J, Vaupel JW (2002) Broken limits to life expectancy. Science 296:1029–1031

    Article  PubMed  CAS  Google Scholar 

  35. Pietropaoli AP, Glance LG, Oakes D, Fisher SG (2010) Gender differences in mortality in patients with sever sepsis or septic shock. Gend Med 7:422–437

    Article  PubMed  Google Scholar 

  36. Fowler RA, Sabur N, Li P, Juurlink DN, Pinto R, Hladunewich MA, Adhikari NKJ, Sibbald WJ, Martin CM (2007) Sex- and age-based differences in the delivery and outcomes of critical care. CMAJ 177:1513–1519

    Article  PubMed  Google Scholar 

  37. Reinikainen M, Niskanen M, Uusaro A, Ruokonen E (2005) Impact of gender on treatment and outcome of ICU patients. Acta Anaesthesiol Scand 49:984–990

    Article  PubMed  CAS  Google Scholar 

  38. Valentin A, Jordan B, Lang T, Hiesmayr M, Metnitz PGH (2003) Gender-related differences in intensive care: a multiple center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med 31:1901–1907

    Article  PubMed  Google Scholar 

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We thank the members of the ASDI study group and their study coordinators in each ICU for their valuable contribution.

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Correspondence to Gerald C. Ihra.

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Philipp G. H. Metnitz: senior author.

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Ihra, G.C., Lehberger, J., Hochrieser, H. et al. Development of demographics and outcome of very old critically ill patients admitted to intensive care units. Intensive Care Med 38, 620–626 (2012).

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