Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital

Abstract

Aim:To study all the elderly patients (≥75 years) who were admitted in an Intensive Care Unit (ICU) of a Spanish hospital and identify factors associated with mortality.Patients and Methods:A retrospective, observational data collected prospectively in patients ≥75 years recruited from the ICU in the period of January 2004 to December 2010.Results:During the study period, 1661 patients were admitted to our unit, of whom 553 (33.3%) were older than 75 years. The mean age was 79.9 years, 317 (57.3%) were male, and the overall in-hospital mortality was 94 patients (17% confidence interval 14–20.3%). When comparing patients who survived to those who died, we found significant differences in mean age (P = 0.001), Acute Physiologic Assessment and Chronic Health Evaluation II and Simplified Acute Physiology Scoring II (SAPS II) on admission (P < 0.0001, postoperative patients (P = 0.001), and need for mechanical ventilation (P < 0.0001). Comparing age groups, we found statistically significant differences in SAPS II (P = 0.007), diagnosis of non-ST-segment elevation myocardial infarction (P = 0.014), complicated postoperative period (P = 0.001), and pacemaker (P = 0.034). Mortality between the groups was statistically significant (P = 0.004). The survival between the group of 65 and 74 years and patients >75 years was not significant (P = 0.1390).Conclusions:The percentage of elderly patients in our unit is high, with low mortality rates. The age itself is not the sole determinant for admission to the ICU and other factors should be taken into account.

Perfil clínico de longevos em uma unidade de terapia intensiva

“…Most of these, like in the present study, also entered through the emergency service. (2) In addition, in another study, sepsis had an impact on the mortality of elderly patients hospitalized at an ICU, regardless of the length of hospital stay. (11) Hence, it is observed that the clinical demands of the long-living patients in the ICU stand out in comparison to the surgical demands, possibly due to the worsening of chronic problems.…”

“…(6) This result, however, diverges from other studies that indicate a prevalence of hospitalizations of male patients, justified by the fact that men are more negligent with their health and are at greater risk of clinical decompensation. (2,(7)(8)(9) Most of the long-living patients came to the ICU for the emergency unit. Their most prevalent comorbidities were hypertension, diabetes and other heart diseases, with hypertension and diabetes being present in the majority.…”

“…With regard to mortality, unfavorable outcomes were associated with long-living elderly coming from the emergency service, with compromised neurological condition, ventilation status, skin condition and hydration upon admission, in line with other authors. (1,2,15) In view of the above, it is necessary to discuss the criteria for the hospitalization of elderly in the ICU, in view of the professionals' difficulties to establish safe criteria for the admission of these people, and in view of continuing uncertainties as to when the benefit is greater than the risk. (11) In this respect, after favorable clinical trials, the use of the APACHE II score, which evaluates 12 physiological parameters, has been indicated as a gold standard to predict mortality in elderly patients.…”

“…(11) In this respect, after favorable clinical trials, the use of the APACHE II score, which evaluates 12 physiological parameters, has been indicated as a gold standard to predict mortality in elderly patients. (2) In addition, it is necessary to review the instruments used to approach the elderly, as important data for their monitoring and prognosis are not being evaluated or valued, such as prior functional status, marital status, context of life, among others, relevant to plan the care and discharge.…”

“…(1) This fact also promotes an increase in these people's demand for hospitalization, including in intensive care units (ICU), where health professionals have perceived this reality. (2) Regarding longevity, a prospective study carried out over a period of 30 months at a general ICU of Hospital do Servidor Público Estadual de São Paulo, published in 2016, identified that 18.2% of the patients admitted in the period were 80 years old or older. Among these, ICU mortality was 26.3%, in hospital 45.7% and 48.4% in the 180 days after hospital admission.…”