Aging and Post–Intensive Care Syndrome: A Critical Need for Geriatric Psychiatry

Abstract

Because of the aging of the intensive care unit (ICU) population and an improvement in survival rates after ICU hospitalization, an increasing number of older adults are suffering from long-term impairments because of critical illness, known as post-intensive care syndrome (PICS). This article focuses on PICS-related cognitive, psychological, and physical impairments and the impact of ICU hospitalization on families and caregivers. The authors also describe innovative models of care for PICS and what roles geriatric psychiatrists could play in the future of this rapidly growing population.

Raising awareness of the needs of older COVID patients after hospital discharge

“…About 40% of patients suffer from polyneuropathy, neuromyopathy, or myopathy, which can result in muscle deconditioning [16]. Three months after discharge from the ICU after critical sepsis, about half of older survivors have functional recovery, and older survivors of sepsis develop 1.5 new limitations in the activities of daily living compared to 0.5 limitations in their non-ICU counterparts [13]. This may explain the greater need for community services, or the higher rates of institutionalization for rehabilitation or nursing care observed after discharge in this age group [3,4].…”

“…The multi-domain cognitive impairments appear to be linked to hypo-or hyperglycaemia, delirium and in-hospital acute stress [16]. The lesions observed in long-term post-ICU cognitive impairment seem to be different from those seen in Alzheimer's disease, with smaller superior frontal lobe, thalamus and cerebellar volume associated with white matter damage [13]. In a random sample of 10,348 subjects who received intensive care and survived to discharge, during 3 years of follow-up, the incidence of newly diagnosed dementia was 15% in ICU survivors, versus 12.2% in matched controls [18].…”

“…Female sex, lower education level, anxiety, pre-existing depression or post-traumatic stress disorder and alcohol abuse may all increase the risk of ICU-acquired mental illness [19]. Among adult ICU survivors, the prevalence is 19-37% for depression, 32-40% for anxiety and 19-22% for post-traumatic stress [13,[19][20][21]. Anxiety, depression and sleep disorders can last months to years, while post-traumatic stress disorder can persist for up to 8 years [5].…”

“…Old patients recovering from severe respiratory illness present secondary disability resulting from intensive treatments. This includes (but is not limited to) acute unit-acquired weakness, long-term cognitive impairment, and poor mental outcomes [4,5,12], while the patient's family members, especially the older ones, will suffer a high psychological burden [13,14].…”

Individualizing Care for a Vulnerable Population: A Look at the AHA Scientific Statement on Older Adults in the Cardiac Intensive Care Unit

“…Delirium and postÀintensive care unit syndrome (PICS) affect long-term cognitive function, and elderly patients are at high risk for both. 4 Multiple interventions during the intensive care unit (ICU) stay, including optimizing the environment to limit sound, active mobilization, and use of light, all can be used to reduce the risks of delirium and PICS. 5 Implementation of the ABCDEF bundle (Assess, Prevent, and Manage Pain; Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; Choice of Analgesia and Sedation; Delirium: Assess, Prevent, and Manage; Early Mobility and Exercise; and Family Engagement and Empowerment) have been shown to improve outcomes.…”