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Amari T, Matta D, Makita Y, Fukuda K, Miyasaka H, Kimura M, Sakamoto Y, Shimo S, Yamaguchi K. Early Ambulation Shortened the Length of Hospital Stay in ICU Patients after Abdominal Surgery. Clin Pract 2023; 13:1612-1623. [PMID: 38131690 PMCID: PMC10742920 DOI: 10.3390/clinpract13060141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
The optimal time to ambulation remains unclear for intensive care unit (ICU) patients following abdominal surgery. While previous studies have explored various mobilization techniques, a direct comparison between ambulation and other early mobilization methods is lacking. Additionally, the impact of time to ambulation on complications and disuse syndrome prevention requires further investigation. This study aimed to identify the optimal time to ambulation for ICU patients after abdominal surgery and considered its potential influence on complications and disuse syndrome. We examined the relationship between time to ambulation and hospital length of stay (LOS). Patients were categorized into the nondelayed (discharge within the protocol time) and delayed (discharge later than expected) groups. Data regarding preoperative functioning, postoperative complications, and time to discharge were retrospectively collected and analyzed. Of the 274 postsurgical patients managed in the ICU at our hospital between 2018 and 2020, 188 were included. Time to ambulation was a significant prognostic factor for both groups, even after adjusting for operative time and complications. The area under the curve was 0.72, and the cutoff value for time to ambulation was 22 h (sensitivity, 68%; specificity, 77%). A correlation between time to ambulation and complications was observed, with both impacting the hospital LOS (model 1: p < 0.01, r = 0.22; model 2: p < 0.01, r = 0.29). Specific cutoff values for time to ambulation will contribute to better surgical protocols.
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Affiliation(s)
- Takashi Amari
- Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan; (K.F.); (Y.S.); (S.S.)
- Department of Anatomy and Life Structure, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daiki Matta
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Yukiho Makita
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Kyosuke Fukuda
- Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan; (K.F.); (Y.S.); (S.S.)
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Hiroki Miyasaka
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Masami Kimura
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Yuta Sakamoto
- Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan; (K.F.); (Y.S.); (S.S.)
- Graduate School of Health and Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo 181-8612, Japan
| | - Satoshi Shimo
- Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan; (K.F.); (Y.S.); (S.S.)
| | - Kenichiro Yamaguchi
- Department of Rehabilitation, Sainokuni Higashi Omiya Medical Center, 1522 Toro-cho, Kita-ku, Saitama-shi 331-8577, Japan;
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Assessing equity and quality indicators for older people – Adaptation and validation of the Assessing Care of Vulnerable Elders (ACOVE) checklist for the Portuguese care context. BMC Geriatr 2022; 22:561. [PMID: 35790949 PMCID: PMC9256534 DOI: 10.1186/s12877-022-03104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Development has promoted longer and healthier lives, but the rise in the proportion of older adults poses new challenges to health systems. Susceptibilities of older persons resulting from lower knowledge about services availability, health illiteracy, lower income, higher mental decline, or physical limitations need to be identified and monitored to assure the equity and quality of health care. The aim of this study was to develop equity indicators for the Assessing Care of Vulnerable Elders (ACOVE)-3 checklist and perform the first cross-cultural adaptation and validation of this checklist into Portuguese. Methods A scoping literature review of determinants or indicators of health (in)equity in the care of older people was performed. A total of 5 language experts and 18 health professionals were involved in the development and validation of the equity and quality indicators through expert opinion and focus groups. Data collected from focus groups was analyzed through directed or conventional content analysis. The usefulness of the indicators was assessed by analyzing the clinical records of 30 patients. Results The literature review revealed that there was a worldwide gap concerning equity indicators for older people primary health care. A structured and complete checklist composed of equity and quality indicators was obtained, validated and assessed. A significant number of non-screened quality or equity related potential occurrences that could have been avoided if the proposed indicators were implemented were detected. The percentage of non-registered indicators was 76.6% for quality and 96.7% for equity. Conclusions Applying the proposed checklist will contribute to improve the monitoring of the clinical situation of vulnerable older people and the planning of medical and social actions directed at this group. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03104-5.
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Yang J, Cheng Y, Wang R, Wang B. Association between early elevated phosphate and mortality among critically ill elderly patients: a retrospective cohort study. BMC Geriatr 2022; 22:208. [PMID: 35291970 PMCID: PMC8922731 DOI: 10.1186/s12877-022-02920-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/04/2022] [Indexed: 02/08/2023] Open
Abstract
Background Phosphate disturbances are relatively common in hospitalized patients, especially in critically ill patients. The abnormal phosphate levels may indicate an abnormal body condition. However, little is known about the association between elevated serum phosphate and outcome in critically ill elderly patients. Therefore, the purpose of the present study was to investigate the association between early elevated phosphate and mortality in critically ill elderly patients. Methods The present study was a retrospective cohort study based on the medical information mart for intensive care IV (MIMIC-IV) database. Patients with age ≥60 years old were enrolled in the present study. The primary outcome in the present study was ICU mortality. Univariate and multivariate Cox proportional hazard regression analyses were used to evaluate the association between early elevated phosphate and ICU mortality in critically ill elderly patients. Results Twenty-four thousand two hundred eighty-nine patients were involved in this analysis and 2,417 patients died in ICU. The median age of involved patients was 78.4 (67.5, 82.9) years old. The median level of serum phosphate in the survivor group was 3.6 (3.0, 4.3) mg/dL, and the median level of serum phosphate in the non-survivor group was 4.4 (3.4, 5.8) mg/dL. The level of serum phosphate in the non-survivor group was significantly higher than the survivor group (4.4 vs. 3.6, P<0.001). The multivariate Cox proportional hazard regression demonstrated that elevated phosphate was an independent risk factor for ICU mortality, after adjustment for other covariates (HR=1.056, 95%CI: 1.028-1.085, P<0.001). Conclusions In critically ill elderly patients, early elevated phosphate was significantly associated with increased ICU mortality.
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Affiliation(s)
- Jie Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guo Xue Xiang St, Chengdu, 610041, Sichuan Province, China
| | - Yisong Cheng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guo Xue Xiang St, Chengdu, 610041, Sichuan Province, China
| | - Ruoran Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guo Xue Xiang St, Chengdu, 610041, Sichuan Province, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No.37 Guo Xue Xiang St, Chengdu, 610041, Sichuan Province, China.
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Pasin L, Boraso S, Golino G, Fakhr BS, Tiberio I, Trevisan C. The impact of frailty on mortality in older patients admitted to an Intensive Care Unit. Med Intensiva 2022; 46:23-30. [PMID: 34991871 DOI: 10.1016/j.medine.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/24/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Frailty is a relatively new concept for intensivists, and is defined as a status of increased vulnerability to stressors associated with reduced reserve and function of different physiological systems. Supporting the hypothesis that frailty may be an important predictor of poor prognosis among older patients admitted to Intensive Care Unit (ICU), this study seeks to evaluate the association between frailty at ICU admission and short and long-term mortality. DESIGN An unmatched case-control study was carried out. SETTING Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients≥80 years of age admitted to the ICU for medical reasons. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary outcome was 30-day mortality, while secondary outcomes were ICU mortality and mortality at one year. RESULTS Most of the patients were classified as frail at ICU admission (55.3%). The prevalence of frailty was higher among those who died than in those who were alive within 30 days from ICU admission (62.3% vs 48.3%, p=0.01). One-year mortality was higher in frail (84.4%) than in non-frail patients (65.2%, p<0.001). In the logistic regression analysis, after adjusting for potential confounders such as chronic diseases, clinical complexity, cause of ICU admission and use of advanced procedures, frailty was seen to be significantly associated to one-year mortality, but not with ICU mortality or 30-day mortality. DISCUSSION The admission of geriatric patients to the ICU is increasing. Frailty assessment may play an important role in the clinical evaluation of such individuals for triage, but should not be considered a priori as an exclusion criterion for admission.
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Affiliation(s)
- L Pasin
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy.
| | - S Boraso
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - G Golino
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - B S Fakhr
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - I Tiberio
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - C Trevisan
- Department of Medicine (DIMED), Geriatric Unit, University of Padova, Italy
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Andersen FH, Ariansen Haaland Ø, Klepstad P, Flaatten H. Frailty and survival in elderly intensive care patients in Norway. Acta Anaesthesiol Scand 2021; 65:1065-1072. [PMID: 33896003 DOI: 10.1111/aas.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Today, 10%-15% of Norwegian intensive care patients are ≥80 years. This proportion will increase significantly over the next 20 years, but it is unlikely that resources for intensive care increase correspondingly. Thus, it is important to establish which patients among elderly people will benefit from intensive care. The main objective of the study was to investigate the relationships between geriatric scoring tools and 30-day mortality. METHODS The study included 451 Norwegian patients ≥80 years who were included in two prospective European observation studies (VIP (very old intensive care patient)1 of VIP2). Both studies included clinical frailty scale (CFS) while VIP2 also obtained the geriatric scores, comorbidity and polypharmacy score (CPS), Short Form of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and Katz Activity of Daily Living score (Katz ADL). RESULTS Survival after 30 days was 59.9%. Risk factors for 30-day mortality were increasing Sequential Organ Failure Assessment (SOFA) score (odds ratio (OR) 1.30; confidence interval (CI) 95% 1.22-1.39) and (CFS) > 3 (CFS 4: OR 1.96 (CI 95% 1.01-3.81); CFS 5-9: OR 1.81 (CI) 95% 1.12-2.93)). Data from VIP2 showed that CFS was the only independent predictor of 30-day mortality when these scores were tested in multivariate analyses separately together with age, SOFA, and gender (OR 1.21 (95% CI 1.03-1.41)). CONCLUSIONS Elderly intensive care patients had a 30-day survival rate of 59.9%. Factors strongly associated with 30-day mortality were increasing SOFA score and increasing frailty (CFS). Other geriatric scores had no significant association with survival in multivariate analyses.
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Affiliation(s)
- Finn H. Andersen
- Department of Anesthesiology and Intensive Care Ålesund HospitalHelse Møre and Romsdal Health Trust Ålesund Norway
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
| | | | - Pål Klepstad
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
- Department of Intensive Care Clinic of Anesthesia and Intensive Care St. Olavs Hospital Trondheim Norway
| | - Hans Flaatten
- Department of Intensive Care, Anesthesia and Surgical Services Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
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Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 2. Crit Care Clin 2021; 37:221-231. [PMID: 33190772 DOI: 10.1016/j.ccc.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As life expectancy increases and birth rates decline, the geriatric population continues to grow faster than any other age group. Aging is characterized by a progressive physiologic decline that promotes the onset of functional limitation and disability. With the increasing geriatric population, more elderly patients are presenting to emergency departments after trauma, and intensive care units are being met with increasing demand. Rehabilitation is critical in improving quality of life by maximizing physical, cognitive, and psychological recovery from injury or disease.
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Kang Y, Zhang GC, Zhu JQ, Fang XY, Niu J, Zhang Y, Wang XJ. Activities of daily living associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery: An observational cohort study. Medicine (Baltimore) 2021; 100:e26056. [PMID: 34087847 PMCID: PMC8183836 DOI: 10.1097/md.0000000000026056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/30/2021] [Indexed: 01/04/2023] Open
Abstract
Elderly patients who undergo major abdominal surgery are being in increasing numbers. Intensive care unit (ICU) survival is critical for surgical decision-making process. Activities of daily living (ADL) are associated with clinical outcomes in the elderly. We aimed to investigate the relationship between ADL and postoperative ICU survival in elderly patients following elective major abdominal surgery.We conducted a retrospective cohort study involving patients aged ≥65 years admitted to the surgical intensive care unit (SICU) following elective major abdominal surgery. Data from all patients were extracted from the electronic medical records. The Barthel Index (BI) was used to assess the level of dependency in ADL at the time of hospital admission.ICU survivors group had higher Barthel Index (BI) scores than non-survivors group (P < .001). With the increase of BI score, postoperative ICU survival rate gradually increased. The ICU survivals in patients with BI 0-20, BI 21-40, BI 41-60, BI 61-80 and BI 81-100 were 55.7%, 67.6%, 72.4%, 83.3% and 84.2%, respectively. In logistic regression, The Barthel Index (BI) was significantly correlated with the postoperative ICU survival in elderly patients following elective major abdominal surgery (OR = 1.33, 95% CI: 1.20-1.47, P = .02). The area under the receiver operating characteristic (ROC) curve of Barthel Index in predicting postoperative ICU survival was 0.704 (95% CI, 0.638-0.771). Kaplan-Meier survival curve in BI≥30 patients and BI < 30 patients showed significantly different.Activity of daily living upon admission was associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery. The Barthel Index(BI) ≥30 was associated with increased postoperative ICU survival. For the elderly with better functional status, they could be given more surgery opportunities. For those elderly patients BI < 30, these results provide useful information for clinicians, patients and their families to make palliative care decisions.
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Affiliation(s)
- Yu Kang
- Department of Geriatric Medicine
| | | | - Ji-Qiao Zhu
- Department of Liver and Gallbladder Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | | | - Jing Niu
- Department of Geriatric Medicine
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Pugh RJ, Bailey R, Szakmany T, Al Sallakh M, Hollinghurst J, Akbari A, Griffiths R, Battle C, Thorpe C, Subbe CP, Lyons RA. Long-term trends in critical care admissions in Wales. Anaesthesia 2021; 76:1316-1325. [PMID: 33934335 PMCID: PMC10138728 DOI: 10.1111/anae.15466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
As national populations age, demands on critical care services are expected to increase. In many healthcare settings, longitudinal trends indicate rising numbers and proportions of patients admitted to ICU who are older; elsewhere, including some parts of the UK, a decrease has raised concerns with regard to rationing according to age. Our aim was to investigate admission trends in Wales, where critical care capacity has not risen in the last decade. We used the Secure Anonymised Information Linkage Databank to identify and characterise critical care admissions in patients aged ≥ 18 years from 1 January 2008 to 31 December 2017. We categorised 85,629 ICU admissions as youngest (18-64 years), older (65-79 years) and oldest (≥ 80 years). The oldest group accounted for 15% of admissions, the older age group 39% and the youngest group 46%. Relative to the national population, the incidence of admission rates per 10,000 population in the oldest group decreased significantly over the study period from 91.5/10,000 in 2008 to 77.5/10,000 (a relative decrease of 15%), and among the older group from 89.2/10,000 in 2008 to 75.3/10,000 in 2017 (a relative decrease of 16%). We observed significant decreases in admissions with high comorbidity (modified Charlson comorbidity index); increases in the proportion of older patients admitted who were considered 'fit' rather than frail (electronic frailty index); and decreases in admissions with a medical diagnosis. In contrast to other healthcare settings, capacity constraints and surgical imperatives appear to have contributed to a relative exclusion of older patients presenting with acute medical illness.
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Affiliation(s)
- R J Pugh
- Department of Anaesthetics, Glan Clwyd Hospital, Bodelwyddan, UK
| | - R Bailey
- Public Health Medicine, Swansea University, Swansea, UK
| | - T Szakmany
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - M Al Sallakh
- Public Health Medicine, Swansea University, Swansea, UK
| | | | - A Akbari
- Public Health Medicine, Swansea University, Swansea, UK
| | - R Griffiths
- Public Health Medicine, Swansea University, Swansea, UK
| | - C Battle
- Ed Major Critical Care Unit, Morriston Hospital, Swansea, UK
| | - C Thorpe
- Department of Anaesthetics, Ysbyty Gwynedd, Bangor, UK
| | - C P Subbe
- Acute and Critical Care Medicine, School of Medical Sciences, Bangor University, Bangor, UK
| | - R A Lyons
- Public Health Medicine, Swansea University, Swansea, UK
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Pasin L, Boraso S, Golino G, Fakhr BS, Tiberio I, Trevisan C. The impact of frailty on mortality in older patients admitted to an Intensive Care Unit. Med Intensiva 2020; 46:S0210-5691(20)30191-1. [PMID: 32654922 DOI: 10.1016/j.medin.2020.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/27/2020] [Accepted: 05/24/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Frailty is a relatively new concept for intensivists, and is defined as a status of increased vulnerability to stressors associated with reduced reserve and function of different physiological systems. Supporting the hypothesis that frailty may be an important predictor of poor prognosis among older patients admitted to Intensive Care Unit (ICU), this study seeks to evaluate the association between frailty at ICU admission and short and long-term mortality. DESIGN An unmatched case-control study was carried out. SETTING Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients≥80 years of age admitted to the ICU for medical reasons. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary outcome was 30-day mortality, while secondary outcomes were ICU mortality and mortality at one year. RESULTS Most of the patients were classified as frail at ICU admission (55.3%). The prevalence of frailty was higher among those who died than in those who were alive within 30 days from ICU admission (62.3% vs 48.3%, p=0.01). One-year mortality was higher in frail (84.4%) than in non-frail patients (65.2%, p<0.001). In the logistic regression analysis, after adjusting for potential confounders such as chronic diseases, clinical complexity, cause of ICU admission and use of advanced procedures, frailty was seen to be significantly associated to one-year mortality, but not with ICU mortality or 30-day mortality. DISCUSSION The admission of geriatric patients to the ICU is increasing. Frailty assessment may play an important role in the clinical evaluation of such individuals for triage, but should not be considered a priori as an exclusion criterion for admission.
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Affiliation(s)
- L Pasin
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy.
| | - S Boraso
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - G Golino
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - B S Fakhr
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - I Tiberio
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - C Trevisan
- Department of Medicine (DIMED), Geriatric Unit, University of Padova, Italy
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Guillon A, Hermetet C, Barker KA, Jouan Y, Gaborit C, Ehrmann S, Le Manach Y, Dequin PF, Grammatico-Guillon L. Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity score-matched cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:384. [PMID: 32600392 PMCID: PMC7325055 DOI: 10.1186/s13054-020-03100-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
Background Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the 2 years after discharge in mortality, healthcare utilisation and frailty score between elderly survivors of ARI in the ICU and an elderly control population. Methods We used 2009–2017 data from 39 hospital discharge databases. Patients ≥ 80 years old discharged alive from ICU hospitalisation for acute respiratory infection were propensity score-matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilisation and frailty scores in the 2-year periods before and after ICU hospitalisation. Results One thousand two hundred and twenty elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95% CI, 6.1–17.3] higher risk of death at 6 months and 3.6-fold [95% CI, 2.9–4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilisation and frailty score in the 2 years after hospital discharge, whereas healthcare utilisation and frailty scores among controls were stable before and after hospitalisation. Conclusions We observed a substantially increased rate of death in the years following ICU hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.
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Affiliation(s)
- Antoine Guillon
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France.
| | - Coralie Hermetet
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France.,EA EES, Université de Tours, Tours, France
| | - Kimberly A Barker
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Department of Microbiology, Boston University School of Medicine, Boston, MA, USA
| | - Youenn Jouan
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France
| | - Christophe Gaborit
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France.,EA EES, Université de Tours, Tours, France
| | - Stephan Ehrmann
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France.,CIC INSERM 1415, Tours, France
| | - Yannick Le Manach
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, Michael DeGroote School of Medicine, McMaster University and the Perioperative Research Group, Population Health Research Institute, Hamilton, ON, Canada
| | - Pierre-François Dequin
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France
| | - Leslie Grammatico-Guillon
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France
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11
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Haas LEM, Bakhshi-Raiez F, van Dijk D, de Lange DW, de Keizer NF. Outcomes of Intensive Care Patients Older Than 90 Years: An 11-Year National Observational Study. J Am Geriatr Soc 2020; 68:1842-1846. [PMID: 32592608 DOI: 10.1111/jgs.16624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES Many intensive care unit (ICU) physicians are reluctant to admit patients aged 90 years and older, although evidence to support these decisions is scarce. Although the body of evidence on outcomes of patients aged 80 years and older is growing, it does not include patients aged 90 years and older. The aim of this study was to compare the short- and long-term mortality of ICU patients aged 90 years and older in the Netherlands with ICU patients aged 80 to 90 years, that is, octogenarians. DESIGN Multicenter national cohort study over an 11-year period (2008-2018), using data of the National Intensive Care Evaluation (NICE) registry and the Dutch insurance claims registry. SETTING All 82 ICUs in the Netherlands. PARTICIPANTS All patients aged 80 years and older at the time of ICU admission. MEASUREMENTS A total of 104,754 patients aged 80 years and older, of whom 9,495 (9%) were 90 years and older, were admitted to Dutch ICUs during the study period. RESULTS ICU mortality of the patients aged 90 years and older was lower (13.8% vs 16.1%; P < .001) and hospital mortality was similar (26.1% vs 25.7%; P = .41) compared with octogenarians. After 3 months, mortality was higher for the patients aged 90 years and older (43.1% vs 33.7%; P < .001) and after 1-year mortality was 55.0% vs 42.7%; P < .001. CONCLUSION In the Netherlands, mortality rates of patients aged 90 years and older admitted to the ICU are not as disappointing as often assumed. They have a lower ICU mortality and a similar hospital mortality compared with octogenarians. Nevertheless, their longer term mortality is higher compared with octogenarians. However, almost 3 of 4 patients leave the hospital alive, and almost half of the patients aged 90 years and older are still alive 1 year after their ICU admission. J Am Geriatr Soc 68:1842-1846, 2020.
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Affiliation(s)
- Lenneke E M Haas
- Department of Intensive Care, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Ferishta Bakhshi-Raiez
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
| | - Diederik van Dijk
- Department of Intensive Care, University Medical Centre, University Utrecht, Utrecht, The Netherlands
| | - Dylan W de Lange
- Department of Intensive Care, University Medical Centre, University Utrecht, Utrecht, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
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Gomes JCP, Dias RD, de Barros JV, Velasco IT, Jacob Filho W. The growing impact of older patients in the emergency department: a 5-year retrospective analysis in Brazil. BMC Emerg Med 2020; 20:47. [PMID: 32527325 PMCID: PMC7291438 DOI: 10.1186/s12873-020-00341-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we know, no other study in Latin America has analyzed the impact of demographic changes in tertiary ED attendance. AIM To describe the sociodemographic characteristics and outcomes of tertiary Brazilian ED users. METHODS Design: Observational cross-sectional analytic study. SETTING Emergency Department, tertiary university hospital, São Paulo, Brazil. PARTICIPANTS patients aged 18 years or older attending a tertiary ED (2009-2013). The primary outcomes were hospitalization and mortality; the secondary outcome was ICU admission. Age was categorized as 'young adults' (18-39y), 'adults' (40-59y), 'young-older adults' (60-79y), and 'old-older adults' (80-109y). Other variables included sex, reason for attendance, time of ED visit, mode of presentation, type of hospitalization, main procedure, length of hospital stay (LOS) and length of ICU stay (ICU-LOS). We calculated descriptive statistics, built generalized linear mixed models for each outcome and estimated Odds Ratios (95% CI) for the independent categorical variables. The significance level was 5% with Bonferroni correction. RESULTS Older age-groups represented 26.6% of 333,028 ED visits, 40.7% of admissions, 42.7% of ICU admissions and 58% of all deaths. Old-older patients accounted for 5.1% of ED visits, 9.5% of admissions and 10.1% of ICU admissions. Hospitalization, ICU admission and mortality rates increased with older age in both sexes. LOS and ICU-LOS were similar across age-groups. The proportions of visits and admissions attributed to young adults decreased annually, while those of people aged 60 or over increased. The ORs for hospitalization, ICU admission and mortality associated with the old-older group were 3.49 (95% CI = 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference. CONCLUSIONS In tertiary ED, age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification.
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Affiliation(s)
- João Carlos Pereira Gomes
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil.
| | - Roger Daglius Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacson Venancio de Barros
- Department of Information Technology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Irineu Tadeu Velasco
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob Filho
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Division of Geriatrics, Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Jones A, Toft-Petersen AP, Shankar-Hari M, Harrison DA, Rowan KM. Demographic Shifts, Case Mix, Activity, and Outcome for Elderly Patients Admitted to Adult General ICUs in England, Wales, and Northern Ireland. Crit Care Med 2020; 48:466-474. [PMID: 32205592 DOI: 10.1097/ccm.0000000000004211] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Major increases in the proportion of elderly people in the population are predicted worldwide. These population increases, along with improving therapeutic options and more aggressive treatment of elderly patients, will have major impact on the future need for healthcare resources, including critical care. Our objectives were to explore the trends in admissions, resource use, and risk-adjusted hospital mortality for older patients, admitted over a 20-year period between 1997 and 2016 to adult general ICUs in England, Wales, and Northern Ireland. DESIGN RETROSPECTIVE ANALYSIS OF NATIONAL CLINICAL AUDIT DATABASE. SETTING The Intensive Care National Audit & Research Centre Case Mix Programme Database, the national clinical audit for adult general ICUs in England, Wales, and Northern Ireland. PATIENTS All adult patients 16 years old or older admitted to adult general ICUs contributing data to the Case Mix Programme Database between January 1, 1997, and December 31, 2016. MEASUREMENTS AND MAIN RESULTS The annual number, trends, and outcomes for patients across four age bands (16-64, 65-74, 75-84, and 85+ yr) admitted to ICUs contributing to the Case Mix Programme Database from 1997 to 2016 were examined. Case mix, activity, and outcome were described in detail for the most recent cohort of patients admitted in 2015-2016. Between 1997 to 2016, the annual number of admissions to ICU of patients in the older age bands increased disproportionately, with increases that could not be explained solely by general U.K. demographic shifts. The risk-adjusted acute hospital mortality decreased significantly within each age band over the 20-year period of the study. Although acute severity at ICU admission was comparable with that of the younger age group, apart from cardiovascular and renal dysfunction, older patients received less organ support. Older patients stayed longer in hospital post-ICU discharge, and hospital mortality increased with age, but the majority of patients surviving to hospital discharge returned home. CONCLUSIONS Over the past two decades, elderly patients have been more commonly admitted to ICU than can be explained solely by the demographic shift. Importantly, as with the wider population, outcomes in elderly patients admitted to ICU are improving over time, with most patients returning home.
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Affiliation(s)
- Andrew Jones
- Intensive Care National Audit & Research Centre, London, United Kingdom
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | | | - Manu Shankar-Hari
- Intensive Care National Audit & Research Centre, London, United Kingdom
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
- Division of Infection, Immunity and Inflammation, Kings College London, London, United Kingdom
| | - David A Harrison
- Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Kathryn M Rowan
- Intensive Care National Audit & Research Centre, London, United Kingdom
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Emerson P, Green DR, Stott S, Maclennan G, Campbell MK, Jansen JO. Equity of access to critical care services in Scotland: A Bayesian spatial analysis. J Intensive Care Soc 2020; 22:127-135. [PMID: 34025752 DOI: 10.1177/1751143720914462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background There is increasing evidence that access to critical care services is not equitable. We aimed to investigate whether location of residence in Scotland impacts on the risk of admission to an Intensive Care Unit and on outcomes. Methods This was a population-based Bayesian spatial analysis of adult patients admitted to Intensive Care Units in Scotland between January 2011 and December 2015. We used a Besag-York-Mollié model that allows us to make direct probabilistic comparisons between areas regarding risk of admission to Intensive Care Units and on outcomes. Results A total of 17,596 patients were included. The five-year age- and sex-standardised admission rate was 352 per 100,000 residents. There was a cluster of Council Areas in the North-East of the country which had lower adjusted admission rates than the Scottish average. Midlothian, in South East Scotland had higher spatially adjusted admission rates than the Scottish average. There was no evidence of geographical variation in mortality. Conclusion Access to critical care services in Scotland varies with location of residence. Possible reasons include differential co-morbidity burden, service provision and access to critical care services. In contrast, the probability of surviving an Intensive Care Unit admission, if admitted, does not show geographical variation.
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Affiliation(s)
| | - David R Green
- Department of Geography and Environment, University of Aberdeen, Aberdeen, UK
| | - Steve Stott
- Department of Critical Care Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Graeme Maclennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Jan O Jansen
- Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, USA
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Ruiz LA, Serrano L, España PP, Martinez-Indart L, Gómez A, Uranga A, Castro S, Artaraz A, Zalacain R. Factors influencing long-term survival after hospitalization with pneumococcal pneumonia. J Infect 2019; 79:542-549. [DOI: 10.1016/j.jinf.2019.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022]
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Bassford C, Griffiths F, Svantesson M, Ryan M, Krucien N, Dale J, Rees S, Rees K, Ignatowicz A, Parsons H, Flowers N, Fritz Z, Perkins G, Quinton S, Symons S, White C, Huang H, Turner J, Brooke M, McCreedy A, Blake C, Slowther A. Developing an intervention around referral and admissions to intensive care: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BackgroundIntensive care treatment can be life-saving, but it is invasive and distressing for patients receiving it and it is not always successful. Deciding whether or not a patient will benefit from intensive care is a difficult clinical and ethical challenge.ObjectivesTo explore the decision-making process for referral and admission to the intensive care unit and to develop and test an intervention to improve it.MethodsA mixed-methods study comprising (1) two systematic reviews investigating the factors associated with decisions to admit patients to the intensive care unit and the experiences of clinicians, patients and families; (2) observation of decisions and interviews with intensive care unit doctors, referring doctors, and patients and families in six NHS trusts in the Midlands, UK; (3) a choice experiment survey distributed to UK intensive care unit consultants and critical care outreach nurses, eliciting their preferences for factors used in decision-making for intensive care unit admission; (4) development of a decision-support intervention informed by the previous work streams, including an ethical framework for decision-making and supporting referral and decision-support forms and patient and family information leaflets. Implementation feasibility was tested in three NHS trusts; (5) development and testing of a tool to evaluate the ethical quality of decision-making related to intensive care unit admission, based on the assessment of patient records. The tool was tested for inter-rater and intersite reliability in 120 patient records.ResultsInfluences on decision-making identified in the systematic review and ethnographic study included age, presence of chronic illness, functional status, presence of a do not attempt cardiopulmonary resuscitation order, referring specialty, referrer seniority and intensive care unit bed availability. Intensive care unit doctors used a gestalt assessment of the patient when making decisions. The choice experiment showed that age was the most important factor in consultants’ and critical care outreach nurses’ preferences for admission. The ethnographic study illuminated the complexity of the decision-making process, and the importance of interprofessional relationships and good communication between teams and with patients and families. Doctors found it difficult to articulate and balance the benefits and burdens of intensive care unit treatment for a patient. There was low uptake of the decision-support intervention, although doctors who used it noted that it improved articulation of reasons for decisions and communication with patients.LimitationsLimitations existed in each of the component studies; for example, we had difficulty recruiting patients and families in our qualitative work. However, the project benefited from a mixed-method approach that mitigated the potential limitations of the component studies.ConclusionsDecision-making surrounding referral and admission to the intensive care unit is complex. This study has provided evidence and resources to help clinicians and organisations aiming to improve the decision-making for and, ultimately, the care of critically ill patients.Future workFurther research is needed into decision-making practices, particularly in how best to engage with patients and families during the decision process. The development and evaluation of training for clinicians involved in these decisions should be a priority for future work.Study registrationThe systematic reviews of this study are registered as PROSPERO CRD42016039054, CRD42015019711 and CRD42015019714.FundingThe National Institute for Health Research Health Services and Delivery Research programme. The University of Aberdeen and the Chief Scientist Office of the Scottish Government Health and Social Care Directorates fund the Health Economics Research Unit.
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Affiliation(s)
- Chris Bassford
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Anaesthesia, Critical Care and Pain, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Mia Svantesson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mandy Ryan
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nicolas Krucien
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sophie Rees
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen Rees
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Agnieszka Ignatowicz
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Nadine Flowers
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Zoe Fritz
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Acute Medicine, Cambridge University Hospitals NHS Trust, Cambridge, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Gavin Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Sarah Quinton
- Warwick Medical School, University of Warwick, Coventry, UK
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | | - Huayi Huang
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jake Turner
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mike Brooke
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Aimee McCreedy
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Caroline Blake
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Anne Slowther
- Warwick Medical School, University of Warwick, Coventry, UK
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Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study. Crit Care Med 2019; 47:15-22. [PMID: 30444743 DOI: 10.1097/ccm.0000000000003424] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Clear understanding of the long-term consequences of critical care survivorship is essential. We investigated the care process and individual factors associated with long-term mortality among ICU survivors and explored hospital use in this group. DESIGN Population-based data linkage study using the Secure Anonymised Information Linkage databank. SETTING All ICUs between 2006 and 2013 in Wales, United Kingdom. PATIENTS We identified 40,631 patients discharged alive from Welsh adult ICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome was 365-day survival. The secondary outcomes were 30- and 90-day survival and hospital utilization in the 365 days following ICU discharge. Kaplan-Meier curves were plotted to compare survival rates. Cox proportional hazards regression models were used to determine risk factors of mortality. Seven-thousand eight-hundred eighty-three patients (19.4%) died during the 1-year follow-up period. In the multivariable Cox regression analysis, advanced age and comorbidities were significant determinants of long-term mortality. Expedited discharge due to ICU bed shortage was associated with higher risk. The rate of hospitalization in the year prior to the critical care admission was 28 hospitalized days/1,000 d; post critical care was 88 hospitalized days/1,000 d for those who were still alive; and 57 hospitalized days/1,000 d and 412 hospitalized days/1,000 d for those who died by the end of the study, respectively. CONCLUSIONS One in five ICU survivors die within 1 year, with advanced age and comorbidity being significant predictors of outcome, leading to high resource use. Care process factors indicating high system stress were associated with increased risk. More detailed understanding is needed on the effects of the potentially modifiable factors to optimize service delivery and improve long-term outcomes of the critically ill.
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Heydari A, Sharifi M, Moghaddam AB. Challenges and Barriers to Providing Care to Older Adult Patients in the Intensive Care Unit: A Qualitative Research. Open Access Maced J Med Sci 2019; 7:3682-3690. [PMID: 32010399 PMCID: PMC6986530 DOI: 10.3889/oamjms.2019.846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND: Enhancing the quality of care for elderly patients needs an understanding of the challenges and obstacles experienced by the intensive care unit (ICU) staff in providing care. AIM: To explore the most challenging issues experienced by ICU staff, in particular, nurses, in the care of elderly patients in the general adult ICU. DESIGN: A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) were followed. METHODS: Based on theoretical sampling, we carried out 34 in-depth semi-structured interviews from two medical adult ICUs. Data analysis was carried out using qualitative conventional content analysis. RESULTS: Data analysis led to the identification of three interrelated categories and 12 subcategories. Three main categories were factors related to nurses’ attitude in elderly care, factors related to the system of care, and factors related to the models of patient care delivery. These categories came under the main theme of “Inappropriate and unfair system for elderly care”. CONCLUSION: The findings of this study increase scholarly understanding of challenges and barriers to providing care to elderly patients in the general adult ICU. We found that the provision of care to elderly patients is inappropriate and unfair. Various obstacles must be overcome to improve the care of these patients. For example, negative attitudes toward elder care, inappropriate environments, lack of resources, lack of knowledge and skills, a specialized model of care delivery, respect for humanity, care without considering patient age, and separating professional conflicts from patient care. These findings may be used by ICU’s caregivers and managers to improve the quality of care. IMPLICATIONS FOR PRACTICE: Various obstacles were documented that need to be overcome by hospital administrators, nursing managers, clinical nurses, nursing educators, nursing researchers to improve the care of elderly patients admitted to ICU.
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Affiliation(s)
- Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadhesam Sharifi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Bagheri Moghaddam
- Department of Anesthesiology, Internal Medicine and Critical Care, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Fragilidad en pacientes mayores de 65 años ingresados en cuidados intensivos (FRAIL-ICU). Med Intensiva 2019; 43:395-401. [DOI: 10.1016/j.medin.2019.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 11/16/2022]
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Wang PY, Takemura N, Xu X, Cheung DST, Lin CC. Predictors of successful discharge from intensive care units in older adults aged 80 years or older: A population-based study. Int J Nurs Stud 2019; 100:103339. [PMID: 31590116 DOI: 10.1016/j.ijnurstu.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 04/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND We determined the long-term outcomes of adult intensive care unit (ICU) patients and investigated the predictors of successful discharge for ≥6 months among older adults aged ≥80 years in Taiwan. OBJECTIVES To identify the predictors of ICU admission in patients aged ≥80 years and the predictors of and optimal cutoff predictive discharge score (PDS) for ICU successful discharge in patients aged ≥80 years. DESIGN A population-based retrospective cohort study. SETTINGS AND PARTICIPANTS Medical records of 282,269 individuals aged ≥80 years collected from the Taiwan National Health Insurance Research Database from 2001 to 2013. METHODS Demographic and clinical parameters, Charlson's comorbidity index (CCI), hospital type, and post-discharge outcomes of ICU patients aged ≥80 years were obtained from their medical records. Multivariable logistic regression was used to analyze and identify the predictors of successful discharge and treatments received by critically ill patients aged ≥80 years admitted to the ICU. The optimal cutoff PDS for successful discharge in older adults were calculated by Youden Index. Results 65,756 ICU admissions were documented, of which 21% (n = 13,825) were for adults aged ≥80 years. The successful discharge rate among ICU patients aged ≥80 years (57.2%) was significantly lower than that among those aged 18-64 and 65-79 years (81.7% and 71.5%, respectively). Multivariable logistic regression analyses revealed the following predictors of successful discharge for ≥6 months after ICU admission in adults aged ≥80 years: younger age (adjusted odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.94-0.96), shorter ICU length of stay (adjusted OR = 0.90, 95% CI = 0.88-0.92), lower CCI (adjusted OR = 0.92, 95% CI = 0.90-0.93), and no life-sustaining treatments received (Cardiopulmonary resuscitation: adjusted OR = 0.75, 95% CI = 0.68-0.84; mechanical ventilation: adjusted OR = 0.63, 95% CI = 0.57-0.71; use of inotropic agents: adjusted OR = 0.37, 95% CI = 0.34-0.41). The optimal cutoff PDS in older adults was 6 (area under the receiver operating characteristic curve = 0.73, 95% CI = 0.72-0.74). CONCLUSION This is the first population-based study investigating the post-discharge outcomes of ICU patients aged ≥80 years. Advanced age was a predictive factor of unsuccessful discharge from the ICU. Nevertheless, more than half of this vulnerable population survived for at least 6 months after discharge. Therefore, age should not be the sole criterion when considering ICU admission and deciding curative treatments for critically ill older adults. Comprehensive assessment and effective communication with patients and their families are also crucial in clinical decision-making for critically ill older adults.
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Affiliation(s)
- Pei-Yi Wang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Haas LEM, van Beusekom I, van Dijk D, Hamaker ME, Bakhshi-Raiez F, de Lange DW, de Keizer NF. Healthcare-related costs in very elderly intensive care patients. Intensive Care Med 2018; 44:1896-1903. [PMID: 30255319 DOI: 10.1007/s00134-018-5381-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/19/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The long-term outcome of "very old intensive care unit patients" (VOPs; ≥ 80 years) is often disappointing. Little is known about the healthcare costs of these VOPs in comparison to younger ICU patients and the very elderly in the general population not admitted to the ICU. METHODS Data from a national health insurance claims database and a national quality registry for ICUs were combined. Costs of VOPs admitted to the ICU in 2013 were compared with costs of younger ICU patients (two groups, respectively 18-65 and 65-80 years old) and a matched control group of very elderly subjects who were not admitted to the ICU. We compared median costs and median costs per day alive in the year before ICU admission (2012), the year of ICU admission (2013) and the year after ICU admission (2014). RESULTS A total of 9272 VOPs were included and compared to three equally sized study groups. Median costs for VOPs in 2012, 2013 and 2014 (€5944, €35,653 and €12,565) are higher compared to the ICU 18-65 population (€3022, €30,223 and €5052, all p < 0.001) and the very elderly control population (€3590, €4238 and €4723, all p < 0.001). Compared to the ICU 65-80 population, costs of VOPs are higher in the year before and after ICU admission (€4323 and €6750, both p < 0.001), but not in the year of ICU admission (€34,448, p = 0.950). The median healthcare costs per day alive in the year before, the year of and the year after ICU admission are all higher for VOPs than for the other groups (p < 0.001). CONCLUSIONS VOPs required more healthcare resources in the year before, the year of and the year after ICU admission compared to younger ICU patients and the very elderly control population, except compared to the ICU 65-80 population in the year of ICU admission. Healthcare costs per day alive, however, are substantially higher for VOPs than for all other study groups in all three studied years.
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Affiliation(s)
- L E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis Utrecht, PO box 80250, 3508 TG, Utrecht, The Netherlands.
| | - Ilse van Beusekom
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
| | - Diederik van Dijk
- Department of Intensive Care Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Marije E Hamaker
- Department of Geriatrics, Diakonessenhuis, Utrecht, The Netherlands
| | - Ferishta Bakhshi-Raiez
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
| | - Dylan W de Lange
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
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Montgomery CL, Rolfson DB, Bagshaw SM. Frailty and the Association Between Long-Term Recovery After Intensive Care Unit Admission. Crit Care Clin 2018; 34:527-547. [PMID: 30223992 DOI: 10.1016/j.ccc.2018.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Frailty is common, although infrequently screened for among patients admitted to intensive care. Frailty has been the focus of research in geriatric medicine; however, its epidemiology and interaction with critical illness have only recently been studied. Instruments to screen for and measure frailty require refinement in intensive care settings. Frail critically ill patients are at higher risk of poor outcomes. Frail survivors of critical illness are high users of health resources. Further research is needed to understand how frailty assessment can inform decision-making before and during an episode of critical illness and during an intensive care course for frail patients.
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Affiliation(s)
- Carmel L Montgomery
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada
| | - Darryl B Rolfson
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 1-198 Clinical Sciences Building, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada.
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Haas LEM, Karakus A, de Keizer NF. The Art of Intensive Care Medicine in the Aging Population. Crit Care Med 2018; 44:e776-7. [PMID: 27428157 DOI: 10.1097/ccm.0000000000001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lenneke E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis, Utrecht, The Netherlands; NICE Foundation, Amsterdam, The Netherlands, and Amsterdam Medical Centre, Department of Medical Informatics, Amsterdam, The Netherlands
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24
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Le Borgne P, Maestraggi Q, Couraud S, Lefebvre F, Herbrecht JE, Boivin A, Michard B, Castelain V, Kaltenbach G, Bilbault P, Schneider F. Critically ill elderly patients (≥ 90 years): Clinical characteristics, outcome and financial implications. PLoS One 2018; 13:e0198360. [PMID: 29856809 PMCID: PMC5983531 DOI: 10.1371/journal.pone.0198360] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/17/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients aged over 90 are being admitted to intensive care units (ICUs) with increasing frequency. The appropriateness of such decisions still remains controversial due to questionable outcome, limited resources and costs. Our objective was to determine the clinical characteristics and outcome in elderly patients (≥ 90 years) admitted in a medical ICU, with an additional focus on medico-economic implications. METHODS We reviewed the charts of all patients (≥ 90 years) admitted to our ICU. We compared them with all other ICU patients (< 90 years), sought to identify ICU mortality predictors and also performed a long-term survival follow-up. RESULTS In the study group of 317 stays: median age was 92 years (IQR: 91-94 years); most patients were female (71.3%.). Acute respiratory failure (52.4%) was the main admission diagnosis; mean SAPS II was 55.6±21.3; half the stays (49.2%) required mechanical ventilation (duration: 7.2±8.8 days); withholding and withdrawing decisions were made for 33.4% of all stays. ICU and hospital mortality rates were 35.7% and 42.6% respectively. Mechanical ventilation (OR = 4.83, CI95%: 1.59-15.82) was an independent predictor of ICU mortality whereas age was not (OR = 0.88, CI95%: 0.72-1.08). Social security reimbursement was significantly lower in the study group compared with all other ICU stays, both per stay (13,160 vs 22,092 Euros, p< 0.01) and per day of stay (p = 0.03). CONCLUSION Among critically ill elderly patients (≥ 90 years), chronological age was not an independent factor of ICU mortality. ICU care-related costs in this population should not be considered as a limiting factor for ICU admission.
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Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France
- * E-mail:
| | - Quentin Maestraggi
- Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Sophie Couraud
- Emergency Department, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - François Lefebvre
- Department of Public Health, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Etienne Herbrecht
- Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Alexandra Boivin
- Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Baptiste Michard
- Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Vincent Castelain
- Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Georges Kaltenbach
- Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France
| | - Francis Schneider
- Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
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Va P, Rali P, Kota H, Keenan V, Mujtaba S, Naing W, Salgunan R, Galperin I, Epelbaum O. Home return following invasive mechanical ventilation for the oldest-old patients in medical intensive care units from two US hospitals. Lung India 2018; 35:461-466. [PMID: 30381553 PMCID: PMC6219131 DOI: 10.4103/lungindia.lungindia_76_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: The aging of the US population has been associated with an increase in intensive care unit (ICU) utilization and correspondingly, invasive mechanical ventilation (IMV) among the oldest-old (age ≥80 years). While previous studies have examined ICU and IMV outcomes in the elderly, very few have focused on patient-centered outcomes, specifically home return, in the oldest-old. We investigated the rate of immediate home return following IMV in the medical ICU in previously home-dwelling oldest-old patients relative to that of a comparison group of 50–70-year olds. Methods: Data were extracted retrospectively from patient records at Elmhurst Hospital Center in Elmhurst, NY, USA, encompassing the period from January 2009 to May 2014 and Jacobi Medical Center in the Bronx, NY, USA, from January 2010 to March 2014. Medical ICU admissions within those date ranges were screened for possible inclusion into one of two study groups based on age: ≥80 years old and 50–70 years old. The primary end point was hospital discharge: home return versus no home return (death or nonhome discharge). Cox proportional hazards’ regression models were used to estimate crude and multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for failure to return home. Results: A total of 375 patients were included in the analysis: 279 (74%) patients aged 50–70 years and 96 (26%) patients aged ≥80 years. Compared to 50–70-year olds, being ≥80 years old was associated with a nearly two-fold greater risk of no home return: adjusted HR: 1.96; 95% CI 1.43–2.67. The oldest-old was at significantly increased risk of both being discharged to a skilled nursing facility or subacute rehabilitation (adjusted HR: 2.19; 95% CI 1.33–3.59) as well as of dying in the hospital (adjusted HR: 1.81; 95% CI 1.21–2.71). Conclusion: Previously home-dwelling oldest-old are at significantly increased risk of failing to return home immediately following medical ICU admission with IMV as compared to patients aged 50–70 years. These results can help medical ICU staff establish appropriate expectations when addressing the families of their oldest patients. Further studies are needed to evaluate the potential for delayed home return among the oldest old and to assess the ability of frailty indices to predict home return within this ICU population.
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Affiliation(s)
- Puthiery Va
- Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Parth Rali
- Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Harshitha Kota
- Department of Internal Medicine, Elmhurst Hospital Center, Elmhurst, NY, USA
| | - Vivian Keenan
- Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Sobia Mujtaba
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Win Naing
- Department of Internal Medicine, Elmhurst Hospital Center, Elmhurst, NY, USA
| | - Reka Salgunan
- Division of Pulmonary and Critical Care Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Irene Galperin
- Division of Pulmonary and Critical Care Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Emerson P, Dodds N, Green DR, Jansen JO. Geographical access to critical care services in Scotland. J Intensive Care Soc 2017; 19:6-14. [PMID: 29456595 DOI: 10.1177/1751143717714948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Critical illness requires specialist and timely management. The aim of this study was to create a geographic accessibility profile of the Scottish population to emergency departments and intensive care units. Methods This was a descriptive, geographical analysis of population access to 'intermediate' and 'definitive' critical care services in Scotland. Access was defined by the number of people able to reach services within 45 to 60 min, by road and by helicopter. Access was analysed by health board, rurality and as a country using freely available geographically referenced population data. Results Ninety-six percent of the population reside within a 45-min drive of the nearest intermediate critical care facility, and 94% of the population live within a 45-min ambulance drive time to the nearest intensive care unit. By helicopter, these figures were 95% and 91%, respectively. Some health boards had no access to definitive critical care services within 45 min via helicopter or road. Very remote small towns and very remote rural areas had poorer access than less remote and rural regions.
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Affiliation(s)
- Philip Emerson
- Department of Intensive Care Medicine, Aberdeen Royal Infirmary, UK
| | - Naomi Dodds
- Department of Anaesthesia, Aberdeen Royal Infirmary, UK
| | - David R Green
- Department of Geography and Environment, University of Aberdeen, UK
| | - Jan O Jansen
- Department of Intensive Care Medicine, Aberdeen Royal Infirmary, UK.,Department of General Surgery, Aberdeen Royal Infirmary, University of Aberdeen, UK.,Health Services Research Unit, University of Aberdeen, UK
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Karakus A, Haas LEM, Brinkman S, de Lange DW, de Keizer NF. Trends in short-term and 1-year mortality in very elderly intensive care patients in the Netherlands: a retrospective study from 2008 to 2014. Intensive Care Med 2017; 43:1476-1484. [DOI: 10.1007/s00134-017-4879-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
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Ruiz LA, España PP, Gómez A, Bilbao A, Jaca C, Arámburu A, Capelastegui A, Restrepo MI, Zalacain R. Age-related differences in management and outcomes in hospitalized healthy and well-functioning bacteremic pneumococcal pneumonia patients: a cohort study. BMC Geriatr 2017. [PMID: 28633626 PMCID: PMC5477680 DOI: 10.1186/s12877-017-0518-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Limited data are available regarding fit and healthy patients with pneumonia at different ages. We evaluated the association of age with clinical presentation, serotype and outcomes among healthy and well-functioning patients hospitalized for bacteremic pneumococcal community–acquired pneumonia. Methods We performed a prospective cohort study of consecutive healthy and well-functioning patients hospitalized for this type of pneumonia. Patients were stratified into younger (18 to 64 years) and older (≥65 years) groups. Results During the study period, 399 consecutive patients were hospitalized with bacteremic pneumococcal pneumonia. We included 203 (50.8%) patients who were healthy and well-functioning patients, of whom 71 (35%) were classified as older. No differences were found in antibiotic treatment, treatment failure rate, antibiotic resistance, or serotype, except for serotype 7F that was less common in older patients. In the adjusted multivariate analysis, the older patients had higher 30-day mortality (OR 6.83; 95% CI 1.22–38.22; P = 0.028), but were less likely to be admitted to the ICU (OR 0.14; 95% CI 0.05–0.39; P < 0.001) and had shorter hospital stays (OR 0.71; 95% CI 0.54–0.94; P = 0.017). Conclusions Healthy and well-functioning older patients have higher mortality than younger patients, but nevertheless, ICU admission was less likely and hospital stays were shorter. These results suggest that the aging process is a determinant of mortality, beyond the functional status of patients with bacteremic pneumococcal pneumonia.
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Affiliation(s)
- Luis A Ruiz
- Pneumology Service, Hospital Universitario Cruces, E-48903, Barakaldo, Bizkaia, Spain.
| | - Pedro P España
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Ainhoa Gómez
- Pneumology Service, Hospital Universitario Cruces, E-48903, Barakaldo, Bizkaia, Spain
| | - Amaia Bilbao
- Research Unit, Hospital Universitario Basurto - Research Network on Health Services for Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain
| | - Carmen Jaca
- Pneumology Service, Hospital Universitario Cruces, E-48903, Barakaldo, Bizkaia, Spain
| | - Amaia Arámburu
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | | | - Marcos I Restrepo
- Division Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System and University of Texas health Science Center, San Antonio, TX, USA
| | - Rafael Zalacain
- Pneumology Service, Hospital Universitario Cruces, E-48903, Barakaldo, Bizkaia, Spain
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Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, Joynt GM, Bagshaw SM, Sprung CL, Benoit D, Soares M, Guidet B. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med 2017; 43:1319-1328. [DOI: 10.1007/s00134-017-4718-z] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/08/2017] [Indexed: 02/01/2023]
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Vallet H, Riou B, Boddaert J. [Elderly patients and intensive care: Systematic review and geriatrician's point of view]. Rev Med Interne 2017; 38:760-765. [PMID: 28215925 DOI: 10.1016/j.revmed.2017.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
Abstract
The global population is aging and intensive care unit admission rate of elderly patients is dramatically increasing. The objective of this review is to provide an overview of the literature about the management of elderly patients in intensive care unit and more specifically about epidemiology, admission criteria, mortality, functional prognosis and ethical aspects. We also discuss the data on cardiorespiratory arrest, shock, acute respiratory failure and delirium. The mortality rate of patients over 80 years old in intensive care unit can reach up to 70% at 1year, but is dependent on many factors, such as comorbidities or frailty. Above all, more than half of elderly patients recover their long-term autonomy. Their quality of life is comparable to that of the same age population. Considering that the first 3months after an intensive care unit stay are the most decisive in terms of vital and functional prognosis, we will discuss strategies to improve care through the creation of dedicated intensive care-geriatrics networks.
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Affiliation(s)
- H Vallet
- Unité périopératoire gériatrique, service de gériatrie, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, DHU FAST, AP-HP, Paris, France; UMR Inserm 1135, Sorbonne universités, UPMC université Paris 6, Paris, France.
| | - B Riou
- UMR Inserm 1166, IHU ICAN, Sorbonne universités, UPMC université Paris 6, Paris, France; Service d'accueil des urgences, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, DHU FAST, AP-HP, Paris, France
| | - J Boddaert
- Unité périopératoire gériatrique, service de gériatrie, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, DHU FAST, AP-HP, Paris, France; UMR Inserm 1166, UMR CNRS 8256, Sorbonne universités, UPMC université Paris 6, Paris, France
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