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

  • Claude Level
  • Eric Tellier
  • Patrick Dezou
  • Karim Chaoui
  • Aissa Kherchache
  • Philippe Sejourné
  • Anne Marie Rullion-Pac Soo
Original Article

Abstract

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.

Keywords

Older persons Intensive care unit Survival Ability and ADL scores Comprehensive geriatric assessment Ethics 

Notes

Acknowledgements

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

Funding

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.

Ethical approval

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.

Informed consent

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.

References

  1. 1.
    Nguyen YL, Angus DC, Boumendil A et al (2011) The challenge of admitting the very elderly to intensive care. Ann Intensive Care 1:29. https://doi.org/10.1186/2110-5820-1-29 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Flaatten H, de Lange DW, Artigas A et al (2017) The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. https://doi.org/10.1007/s00134-017-4718-z Google Scholar
  3. 3.
    Fassier T, Duclos A, Abbas-Chorfa S et al (2016) Elderly patients hospitalized in the ICU in France: a population-based study using secondary data from the national hospital discharge database. J Eval Clin Pract 22:378–386. https://doi.org/10.1111/jep.12497 CrossRefPubMedGoogle Scholar
  4. 4.
    Vosylius S, Sipylaite J, Ivakevicius J (2005) Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing 34:157–162CrossRefPubMedGoogle Scholar
  5. 5.
    Somme D, Maillet JM, Gisselbrecht M et al (2003) Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29:2137–2143CrossRefPubMedGoogle Scholar
  6. 6.
    Brumell NE, Balas MC, Morandi A et al (2015) Understanding and reducing disability in older adults following critical illness. Crit Care Med 43:1265–1275CrossRefGoogle Scholar
  7. 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. 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
  9. 9.
    Ellis G, Marshall T, Ritchie C (2014) Comprehensive geriatric assessment in the emergency department. Clin Interv Aging 9:2033–2043. https://doi.org/10.2147/CIA.S29662 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Cohen HJ, Feussner JR, Weinberg M et al (2002) A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med 346:905–912CrossRefPubMedGoogle Scholar
  11. 11.
    Leblanc G, Boumendil A, Guidet B (2017) Ten things to know about critically ill elderly patients. Intensive Care Med 43:217–219. https://doi.org/10.1007/s00134-016-4477-2 CrossRefPubMedGoogle Scholar
  12. 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
  13. 13.
    Vallet H, Riou B, Boddaert J (2017) Elderly patients and intensive care: Systematic review and geriatrician’s point of view. Rev Med Intern 37:760–765CrossRefGoogle Scholar
  14. 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
  15. 15.
    Peigne V, Somme D, Guérot E et al (2016) Treatment intensity, age and outcome in medical ICU patients: results of a French administrative database. Ann Intensive Care 6:7. https://doi.org/10.1186/s13613-016-0107-y CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Baldwin MR, Narain WR, Wunsch H et al (2013) A prognostic model for 6-month mortality in elderly survivors of critical illness. Chest 143:910–919. https://doi.org/10.1378/chest.12-1668 CrossRefPubMedGoogle Scholar
  17. 17.
    Ducos G, Mathe O, Balardy L et al (2017) Influence of age on decision-making process to limit or withdraw life-sustaining treatment in the intensive care unit—a single center prospective observational study. J Frailty Aging. https://doi.org/10.14283/jfa.2017.22 PubMedGoogle Scholar
  18. 18.
    De Rooij SE, Abu-Hanna A, Levi M et al (2005) Factors that predicts outcome of intensive care treatment in very elderly patients: a review. Crit Care 9:R307–R314CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Andersen FH, Flaatten H, Klepstad P et al (2015) Long-term survival and quality of life after intensive care for patients 80 years of age or older. Ann Intensive Care 5:53. https://doi.org/10.1186/s13613-015-0053-0 CrossRefPubMedGoogle Scholar
  20. 20.
    Roch A, Wiramus S, Pauly V et al (2011) Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care 15:R36. https://doi.org/10.1186/cc9984 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Pisani MA, Redlich CA, Mc Nicoll L et al (2005) Short-term outcomes in older intensive care unit patients with dementia. Crit Care Med 33:1371–1376CrossRefPubMedGoogle Scholar
  22. 22.
    Farfel JM, Franca SA, SitaMdo C et al (2009) Age, invasive ventilatory support and outcomes in elderly patients admitted to intensive care units. Age Ageing 38:15–20CrossRefGoogle Scholar
  23. 23.
    Nierman DM, Schechter CB, Cannon LM, Meier DE (2001) Outcome prediction model for very elderly critically ill patients. Crit Care Med 29:1853–1859CrossRefPubMedGoogle Scholar
  24. 24.
    Barnato AE, Albert SM, Angus DC et al (2011) Disability among elderly survivors of mechanical ventilation. Am J Resp Crit Care Med 183:1037–1042CrossRefPubMedGoogle Scholar
  25. 25.
    Ely EW, Wheeler AP, Thompson BT et al (2002) Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome. Ann Intern Med 136:25–36CrossRefPubMedGoogle Scholar
  26. 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
  27. 27.
    Dardaine V, Dequin PF, Ripault H, Constans T, Giniés G (2001) Outcome of older patients requiring ventilatory support in intensive care: impact of nutritional status. J Am Geriatr Soc 49:564–570CrossRefPubMedGoogle Scholar
  28. 28.
    Rozini R, Sabatini T, Trabucchi M (2006) Non-invasive ventilation for respiratory failure in elderly patients. Age Ageing 35:546–547CrossRefGoogle Scholar
  29. 29.
    Nava S, Grassi M, Fanfulla F et al (2011) Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomised controlled trial. Age Ageing 40:444–450CrossRefPubMedGoogle Scholar
  30. 30.
    Tabah A, Philippart F, Timsit JF et al (2010) Quality of life in patients 80 or over after ICU discharge. Crit Care 14:R2. https://doi.org/10.1186/cc8231 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Katz S (1983) Assessing self-maintenance: activities of daily living, mobility and instrumental activities of daily living. J Am Geratr Soc 31:721–727CrossRefGoogle Scholar
  32. 32.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Med State Med J 14:61–65Google Scholar
  33. 33.
    Belmin J, Auffray JC, Berbezier C et al (2007) Level of dependency: a simple marker associated with mortality during the 2003 heatwave among French dependent elderly people living in the community or in institutions. Age Ageing 36:298–303CrossRefPubMedGoogle Scholar
  34. 34.
    Le Maguet P, Roquilly A, Lasocki S et al (2014) Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med 40:674–682. https://doi.org/10.1007/s00134-014-3253-4 PubMedGoogle Scholar
  35. 35.
    Kara I, Yildirim F, Zerman A et al (2017) The impact of non invasive mechanical ventilation in elderly medical intensive care unit patients. Aging Clin exp Res. https://doi.org/10.1007/s40520-017-0774-z Google Scholar
  36. 36.
    Hennesy D, Juzwishin K, Yergens D et al (2005) Outcomes of elderly survivors of intensive care: a review of the literature. Chest 127:1764–1774CrossRefGoogle Scholar
  37. 37.
    Hofhuis JG, Van Stel HF, Schrijvers AJ et al (2015) ICU survivors show no decline in health-related quality of life after 5 years. Intensive Care Med 41:495–504CrossRefPubMedGoogle Scholar
  38. 38.
    Sacanella E, Perez-Castejon JM et al (2011) Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a retrospective observational study. Crit Care 15:R105. https://doi.org/10.1186/cc10121 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Kaarlola A, Tallgren M, Pettilä V (2006) Long term survival, quality of life and quality adjusted life among critically ill elderly patients. Crit Care Med 34:2120–2126CrossRefPubMedGoogle Scholar
  40. 40.
    Villa P, Pintado MC, Luján J, Gonzalez-García N et al (2016) Functional status and quality of life in elderly intensive care unit survivors. J Am Geriatr Soc 64:536–542CrossRefPubMedGoogle Scholar
  41. 41.
    Boddaert J, Cohen-Bittan J, Khiami F et al (2014) Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patient with hip fracture. Plos One 9:e83795. https://doi.org/10.1371/journal.pone.0083795 CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Liu J, Ahn J, Elkassabany NM (2014) Optimizing perioperative care for patients with hip fracture. Anesthesiol Clin 32:823–839. https://doi.org/10.1016/j.anclin.2014.08.010 CrossRefGoogle Scholar
  43. 43.
    Robert R, Skrifvars MB, Ranzani OT (2017) Is this critically ill patient elderly or too old?. Intensive Care Med. https://doi.org/10.1007/s00134-4965z Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Intensive Care UnitJean Rougier HospitalCahorsFrance
  2. 2.Emergency DepartmentPellegrin HospitalBordeauxFrance
  3. 3.Geriatric Medical UnitNerac HospitalNeracFrance
  4. 4.Intensive Care UnitSaint Esprit HospitalAgenFrance
  5. 5.Department of Medical ComputingSaint Esprit HospitalAgenFrance

Personalised recommendations