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Socio-Economic Reintegration After Critical Illness

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Improving Critical Care Survivorship

Abstract

The social and financial costs for patients, caregivers, and family of a critical care admission are staggering. The enforced absence from the usual social and economic roles results in both financial toxicity and social isolation that can limit recovery. The process known as socio-economic reintegration after critical illness can be defined as:

The resumption of relationships, roles, and financial income after a period of critical illness. This should include family, friends, nurturing and supportive roles, reclaiming interests, as well as returning to work (if of employment age).

Solutions should start from the moment a patient is admitted to hospital. After hospital discharge, patients and caregivers need support and guidance on how to return to their previous lives. This process needs to be guided by patients and family while involving the wider multidisciplinary team including medical teams, financial experts, employers, and peers.

Ultimately, champions are needed to raise awareness within governments and broader society in order to improve socio-economic reintegration after critical illness.

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References

  1. Zafar SY, Abernethy AP. Financial toxicity, part I: a new name for a growing problem. Oncology (Williston Park, NY). 2013;27:80.

    Google Scholar 

  2. McIntyre D, Thiede M, Dahlgren G, Whitehead M. What are the economic consequences for households of illness and of paying for health care in low-and middle-income country contexts? Soc Sci Med. 2006;62:858–65.

    Article  PubMed  Google Scholar 

  3. Dranove D, Millenson ML. Medical bankruptcy: myth versus fact: this response to a widely cited paper by David Himmelstein and colleagues challenges the basis of its conclusions. Health Aff. 2006;25:W74–83.

    Article  Google Scholar 

  4. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33:1266–71.

    Article  PubMed  Google Scholar 

  5. Covinsky KE, Goldman L, Cook EF, et al. The impact of serious illness on patients’ families. JAMA. 1994;272:1839–44.

    Article  CAS  PubMed  Google Scholar 

  6. Li AK, Covinsky KE, Sands LP, Fortinsky RH, Counsell SR, Landefeld CS. Reports of financial disability predict functional decline and death in older patients discharged from the hospital. J Gen Intern Med. 2005;20:168–74.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA. 1998;279:1703–8.

    Article  CAS  PubMed  Google Scholar 

  8. Kaplan GA, Pamuk ER, Lynch JW, Cohen RD, Balfour JL. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996;312:999–1003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Herridge MS, Cheung AM, Tansey CM, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348:683–93.

    Article  PubMed  Google Scholar 

  10. Mehlhorn J, Freytag A, Schmidt K, et al. Rehabilitation interventions for postintensive care syndrome: a systematic review. Crit Care Med. 2014;42:1263–71.

    Article  PubMed  Google Scholar 

  11. Griffiths J, Hatch RA, Bishop J, et al. An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. Crit Care. 2013;17:R100.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Swoboda SM, Lipsett PA. Impact of a prolonged surgical critical illness on patients’ families. Am J Crit Care. 2002;11:459–66.

    Article  PubMed  Google Scholar 

  13. McPeake J, Mikkelsen ME, Quasim T, et al. Return to employment following critical illness and its association with psychosocial outcomes: a systematic review and meta-analysis. Ann Am Thorac Soc. 2019;16:1304.

    Article  PubMed  Google Scholar 

  14. Anders B, Ommen O, Pfaff H, et al. Direct, indirect, and intangible costs after severe trauma up to occupational reintegration - an empirical analysis of 113 seriously injured patients. Psycho-Soc Med. 2013;10:Doc02-Doc.

    Google Scholar 

  15. Rothenhäusler H-B, Ehrentraut S, Stoll C, Schelling G, Kapfhammer H-P. The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study. Gen Hosp Psychiatry. 2001;23:90–6.

    Article  PubMed  Google Scholar 

  16. Adhikari NK, McAndrews MP, Tansey CM, et al. Self-reported symptoms of depression and memory dysfunction in survivors of ARDS. Chest. 2009;135:678–87.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Myhren H, Ekeberg Ø, Stokland O. Health-related quality of life and return to work after critical illness in general intensive care unit patients: a 1-year follow-up study. Crit Care Med. 2010;38:1554–61.

    Article  PubMed  Google Scholar 

  18. Kamdar BB, Huang M, Dinglas VD, et al. Joblessness and lost earnings after acute respiratory distress syndrome in a 1-year national multicenter study. Am J Respir Crit Care Med. 2017;196:1012–20.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Choi J, Donahoe MP, Zullo TG, Hoffman LA. Caregivers of the chronically critically ill after discharge from the intensive care unit: six months’ experience. Am J Crit Care. 2011;20:12–23.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ågård AS, Egerod I, Tønnesen E, Lomborg K. Struggling for independence: a grounded theory study on convalescence of ICU survivors 12 months post ICU discharge. Intens Crit Care Nurs. 2012;28:105–13.

    Article  Google Scholar 

  21. Hawton A, Green C, Dickens AP, et al. The impact of social isolation on the health status and health-related quality of life of older people. Qual Life Res. 2011;20:57–67.

    Article  PubMed  Google Scholar 

  22. Peplau LA. Perspective on loneliness. In: Lonelinss: a sourcebook of current theory, research and therapy; 1982.

    Google Scholar 

  23. Victor C, Scambler S, Bond J. The social world of older people: understanding loneliness and social isolation in later life: understanding loneliness and social isolation in later life: McGraw-Hill Education (UK); 2008.

    Google Scholar 

  24. Seeman TE. Health promoting effects of friends and family on health outcomes in older adults. Am J Health Promot. 2000;14:362–70.

    Article  CAS  PubMed  Google Scholar 

  25. Freyne A, Fahy S, McAleer A, Keogh F, Wrigley M. A longitudinal study of depression in old age I: outcome and relationship to social networks. Ir J Psychol Med. 2005;22:87–93.

    Article  PubMed  Google Scholar 

  26. Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol. 1979;109:186–204.

    Article  CAS  PubMed  Google Scholar 

  27. Gerst-Emerson K, Jayawardhana J. Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults. Am J Public Health. 2015;105:1013–9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hill A, Fowler R, Pinto R, Herridge M, Cuthbertson B, Scales D. Long-term outcomes and healthcare utilization following critical illness–a population-based study. Crit Care. 2016;20:76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Cacioppo JT, Cacioppo S. Social relationships and health: the toxic effects of perceived social isolation. Soc Personal Psychol Compass. 2014;8:58–72.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Arthur HM. Depression, isolation, social support, and cardiovascular disease in older adults. J Cardiovasc Nurs. 2006;21:S2–7.

    Article  PubMed  Google Scholar 

  31. Teo AR. Social isolation associated with depression: a case report of hikikomori. Int J Soc Psychiatry. 2013;59:339–41.

    Article  PubMed  Google Scholar 

  32. Kuiper JS, Zuidersma M, Voshaar RCO, et al. Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2015;22:39–57.

    Article  PubMed  Google Scholar 

  33. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10:227–37.

    Article  PubMed  Google Scholar 

  34. Mihalopoulos C, Le LK-D, Chatterton ML, et al. The economic costs of loneliness: a review of cost-of-illness and economic evaluation studies. Soc Psychiatry Psychiatr Epidemiol. 2019:1–14.

    Google Scholar 

  35. Deja M, Denke C, Weber-Carstens S, et al. Social support during intensive care unit stay might improve mental impairment and consequently health-related quality of life in survivors of severe acute respiratory distress syndrome. Crit Care. 2006;10:R147.

    Article  PubMed  PubMed Central  Google Scholar 

  36. McPeake J, Henderson P, Darroch G, et al. Social and economic problems of ICU survivors identified by a structured social welfare consultation. Crit Care. 2019;23:153.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Cancelliere C, Donovan J, Stochkendahl MJ, et al. Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews. Chiropractic Man Ther. 2016;24:32.

    Article  Google Scholar 

  38. Bandura A. Self-efficacy. Corsini Encyclopedia Psychol. 2010:1–3.

    Google Scholar 

  39. Mikkelsen MB, Rosholm M. Systematic review and meta-analysis of interventions aimed at enhancing return to work for sick-listed workers with common mental disorders, stress-related disorders, somatoform disorders and personality disorders. Occup Environ Med. 2018;75:675–86.

    Article  PubMed  Google Scholar 

  40. Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008;30:421–34.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Righy C, Rosa RG, da Silva RTA, et al. Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis. Crit Care. 2019;23:213.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Norman BC, Jackson JC, Graves JA, et al. Employment outcomes after critical illness: an analysis of the BRAIN-ICU cohort. Crit Care Med. 2016;44:2003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Baumbach P, Meissner W, Guenther A, Witte OW, Gotz T. Perceived cognitive impairments after critical illness: a longitudinal study in survivors and family member controls. Acta Anaesthesiol Scand. 2016;60:1121–30.

    Article  CAS  PubMed  Google Scholar 

  44. McPeake J, Harhay M, Devine H, et al. Exploring patients’ goals within the intensive care unit rehabilitation setting. Am J Crit Care. 2019;28:393–400.

    Article  PubMed  Google Scholar 

  45. Needham DM, Sepulveda KA, Dinglas VD, et al. Core outcome measures for clinical research in acute respiratory failure survivors. An international modified Delphi consensus study. Am J Respir Crit Care Med. 2017;196:1122–30.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Dinglas VD, Faraone LN, Needham DM. Understanding patient-important outcomes after critical illness: a synthesis of recent qualitative, empirical, and consensus-related studies. Curr Opin Crit Care. 2018;24:401.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Azoulay E, Vincent J-L, Angus DC, et al. Recovery after critical illness: putting the puzzle together—a consensus of 29. Crit Care. 2017;21:296.

    Article  PubMed  PubMed Central  Google Scholar 

  48. McPeake J, Hirshberg EL, Christie LM, et al. Models of peer support to remediate post-intensive care syndrome: a report developed by the society of critical care medicine thrive international peer support collaborative. Crit Care Med. 2019;47:e21–e7.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Wolters AE, Slooter AJ, van der Kooi AW, van Dijk D. Cognitive impairment after intensive care unit admission: a systematic review. Intensive Care Med. 2013;39:376–86.

    Article  PubMed  Google Scholar 

  50. Ohtake PJ, Lee AC, Scott JC, et al. Physical impairments associated with post–intensive care syndrome: systematic review based on the world health organization’s international classification of functioning, disability and health framework. Phys Ther. 2018;98:631–45.

    Article  PubMed  Google Scholar 

  51. Mikkelsen ME, Jackson JC, Hopkins RO, et al. Peer support as a novel strategy to mitigate post-intensive care syndrome. AACN Adv Crit Care. 2016;27:221–9.

    Article  PubMed  Google Scholar 

  52. Haines KJ, Beesley SJ, Hopkins RO, et al. Peer support in critical care: a systematic review. Crit Care Med. 2018;46:1522–31.

    Article  PubMed  Google Scholar 

  53. Pollock A, Baer G, Campbell P, et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev. 2014;(4):CD001920.

    Google Scholar 

  54. Baseman S, Fisher K, Ward L, Bhattacharya A. The relationship of physical function to social integration after stroke. J Neurosci Nurs. 2010;42:237–44.

    Article  PubMed  Google Scholar 

  55. Obembe AO, Eng JJ. Rehabilitation interventions for improving social participation after stroke: a systematic review and meta-analysis. Neurorehabil Neural Repair. 2016;30:384–92.

    Article  PubMed  Google Scholar 

  56. Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67:1–12.

    Article  PubMed  Google Scholar 

  57. Lamberti M, Ratti G, Gerardi D, et al. Work-related outcome after acute coronary syndrome: implications of complex cardiac rehabilitation in occupational medicine. Int J Occup Med Environ Health. 2016;29:649.

    Article  PubMed  Google Scholar 

  58. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. 2016;4:256.

    Article  PubMed  PubMed Central  Google Scholar 

  59. de Boer AG, Taskila TK, Tamminga SJ, Feuerstein M, Frings-Dresen MH, Verbeek JH. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev. 2015;(9):CD007569.

    Google Scholar 

  60. Tikka C, Verbeek J, Tamminga S, Leensen M, de Boer A. Rehabilitation and return to work after cancer: literature review. EU-OSHA: Luxembourg; 2017.

    Google Scholar 

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Henderson, P., Robinson, C., Quasim, T. (2021). Socio-Economic Reintegration After Critical Illness. In: Haines, K.J., McPeake, J., Sevin, C.M. (eds) Improving Critical Care Survivorship. Springer, Cham. https://doi.org/10.1007/978-3-030-68680-2_18

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  • DOI: https://doi.org/10.1007/978-3-030-68680-2_18

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