Skip to main content

Advertisement

SpringerLink
Log in

Short- and long-term outcomes of older patients in intermediate care units

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To evaluate short- and long-term outcomes of elderly patients (≥ 65 years) treated at an intermediate care unit (IMCU) and to identify outcome predictors.

Design and setting

Prospective observational study in the IMCU of a university teaching hospital.

Participants

We studied 412 patients over 8 months, classified into three groups: under 65 years (control group, n = 158), 65–80 (n = 186), and > 80 (n = 68).

Measurements

At admission: APACHE II, TISS-28 first day, Charlson Index, diagnosis, and prior Barthel Index. Outcome measures: in-hospital mortality, length of stay, discharge destination, and 2-year mortality and readmissions. Data analysis included multivariate logistic regression and receiver operating characteristics area under the curve (ROC AUC).

Results

No statistically significant differences between groups were observed in hospital mortality (14.1%), discharge to a long-term facility (2.7%), or 2-year readmissions (1.2 ± 2.1). However, hospital stay was longer in patients aged 65–80 years (14 vs.10 days) and 2-year mortality was higher in those 65 or over (34% vs.10.6%). In the overall series in-hospital mortality was predicted by APACHE II, first-day TISS-28, and diagnosis (ROC AUC 0.81), and 2-year mortality by Charlson Index and age (ROC AUC 0.77). In the elderly patients 2-year mortality was predicted by Charlson and Barthel indices (ROC AUC 0.70).

Conclusions

Illness severity and therapeutic intervention at admission to IMCU were predictors of short-term mortality, whereas the strongest predictor of long-term mortality was comorbidity. Our results suggest that comprehensive assessment of elderly patients at admission to IMCUs may improve outcome prediction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cheng DC, Byrick RJ, Knobel E (1999) Structural models for intermediate care areas. Crit Care Med 27:2266–2271

    Article  PubMed  CAS  Google Scholar 

  2. Dhond G, Ridley S, Palmer M (1998) The impact of a high-dependency unit on the workload of an intensive care unit. Anaesthesia 53:841

    Article  PubMed  CAS  Google Scholar 

  3. Havill JH, Cranston D (1998) The place of the high dependency unit in a modern New Zealand hospital. N Z Med J 111:203–205

    PubMed  CAS  Google Scholar 

  4. Quality of life after mechanical ventilation in the aged study investigators (2002) 2-month mortality and functional status of critically ill adult patients receiving mechanical ventilation. Chest 121:549–558

    Article  Google Scholar 

  5. Djaiani G, Ridley S (1997) Outcome of intensive care in the elderly. Anaesthesia 52:1130–1136

    Article  PubMed  CAS  Google Scholar 

  6. 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 

  7. Hamel MB, Davis RB, Teno JM, Knaus WA, Lynn J, Harrel FJr, Galanos A, Wu AW, Phillips RS (1999) Older age, aggressiveness of care, and survival for seriously ill, hospitalized adults. Ann Intern Med 131:721–728

    PubMed  CAS  Google Scholar 

  8. De Silva RJ, Anderson A, Tempest H, Ridley S (2001) Sequential organ scoring as a measure of effectiveness of care in the high-dependency unit. Anaesthesia 56:850–854

    Article  PubMed  Google Scholar 

  9. Brooks N (2000) Quality of life and the high-dependency unit. Intensive Crit Care Nurs 16:18–32

    Article  PubMed  CAS  Google Scholar 

  10. Ip S, Leung YF, Ip CY, Mak WP (1999) Outcomes of critically ill elderly patients: Is high-dependency care for geriatric patients worthwhile? Crit Care Med 27:2351–2357

    Article  PubMed  CAS  Google Scholar 

  11. Torres OH, Benito S, Ruiz D, Montiel JA, Francia E, Vázquez G (2003) Outcome of elderly patients in an Intermediate Care Area. Sixteenth Annual Congress from the European Society of Intensive Care Medicine; 2003 Oct 5–8; Amsterdam, Netherlands. Intensive Care Med 29 [Suppl 1]:115

  12. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  13. Miranda DR, de Rijk A, Schaufeli W (1996) Simplified Therapeutic Intervention Scoring System: the TISS-28 items-results from a multicenter study. Crit Care Med 24:64–73

    Article  PubMed  CAS  Google Scholar 

  14. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Maryland State Med J 14:61–65

    CAS  Google Scholar 

  15. Wade DT, Collin C (1988) The Barthel ADL Index: a standard measure of physical disability? Int Disabil Studies 10:64–67

    CAS  Google Scholar 

  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  17. Kleinbaum DG, Kupper LL, Muller KE (1988) Applied regression analysis and other multivariables methods. PWS-Kent, Boston

    Google Scholar 

  18. Porath A, Reuveni H, Grinberg G, Lieberman D (1995) The intermediate care unit as a cost-effective option for the treatment of medical patients in critical condition. Isr J Med Sci 31:674–680

    PubMed  CAS  Google Scholar 

  19. Pirret AM (2002) Utilizing TISS to differentiate between intensive care and high-dependency patients and to identify nursing skill requirements. Intensive Crit Care Nurs 18:19–26

    Article  PubMed  Google Scholar 

  20. Wakefield CH, Corry R, Dodds R, Park L Lee A, Fearon KCH (2000) Activities and outcome in the surgical high-dependency setting. Br J Surg 87 [Suppl 1]:54

    Google Scholar 

  21. Ching CK, Yam LY, Lee CH (1997) 6-month survival of patients admitted to a medical high dependency unit. Chest 112 [Suppl 3]:85S

  22. Kass JE, Castriotta RJ, Malakoff F (1992) Intensive care unit outcome in the very elderly. Crit Care Med 20:1666–1971

    Article  PubMed  CAS  Google Scholar 

  23. Mayer-Oakes SA, Oye RK, Leake B (1991) Predictors of mortality in older patients following medical intensive care: the importance of functional status. J Am Geriatr Soc 39:862–868

    PubMed  CAS  Google Scholar 

  24. Roche VML, Kramer A, Hester E, Welsh CH (1999) Long-term functional outcome after intensive care. J Am Geriatr Soc 47:18–24

    PubMed  CAS  Google Scholar 

  25. Boumendil A, Maury E, Reinhard I, Luquel L, Offenstadt G, Guidet B (2004) Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 30:647–654

    Article  PubMed  Google Scholar 

  26. Nierman DM, Schechter CB, Cannon LM, Meier DE (2001) Outcome prediction model for very elderly critically ill patients. Crit Care Med 29:1853–1859

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We thank Carolyn Newey for editorial assistance.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Emergencies, Division of Geriatrics, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Mas Casanovas 90, 08025, Barcelona, Spain

    Olga H. Torres, Esther Francia & Domingo Ruiz

  2. Intermediate Care Unit, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Avgda. Sant Antoni M Claret 167, 08025, Barcelona, Spain

    Vanesa Longobardi & Salvador Benito

  3. Department of Clinical Epidemiology and Statistics, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Avgda. Sant Antoni M Claret 167, 08025, Barcelona, Spain

    Ignasi Gich

Authors
  1. Olga H. Torres
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esther Francia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vanesa Longobardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ignasi Gich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Salvador Benito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Domingo Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olga H. Torres.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-006-0172-z

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Torres, O.H., Francia, E., Longobardi, V. et al. Short- and long-term outcomes of older patients in intermediate care units. Intensive Care Med 32, 1052–1059 (2006). https://doi.org/10.1007/s00134-006-0170-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-006-0170-1

Keywords

Search

Navigation