Characteristics and Outcomes of Very Elderly Patients Admitted to Intensive Care: A Retrospective Multicenter Cohort Analysis*

Abstract

OBJECTIVES: To characterize and compare trends in ICU admission, hospital outcomes, and resource utilization for critically ill very elderly patients (≥ 80 yr old) compared with the younger cohort (16–79 yr old). DESIGN: A retrospective multicenter cohort study. SETTING: One-hundred ninety-four ICUs contributing data to the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database between January 2006 and December 2018. PATIENTS: Adult (≥ 16 yr) patients admitted to Australian and New Zealand ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Very elderly patients with a mean ± sd age of 84.8 ± 3.7 years accounted for 14.8% (232,582/1,568,959) of all adult ICU admissions. They had higher comorbid disease burden and illness severity scores compared with the younger cohort. Hospital (15.4% vs 7.8%, p < 0.001) and ICU mortality (8.5% vs 5.2%, p < 0.001) were higher in the very elderly. They stayed fewer days in ICU, but longer in hospital and had more ICU readmissions. Among survivors, a lower proportion of very elderly was discharged home (65.2% vs 82.4%, p < 0.001), and a higher proportion was discharged to chronic care/nursing home facilities (20.1% vs 7.8%, p < 0.001). Although there was no change in the proportion of very elderly ICU admissions over the study period, they showed a greater decline in risk-adjusted mortality (6.3% [95% CI, 5.9%–6.7%] vs 4.0% [95% CI, 3.7%–4.2%] relative reduction per year, p < 0.001) compared with the younger cohort. The mortality of very elderly unplanned ICU admissions improved faster than the younger cohort (p < 0.001), whereas improvements in mortality among elective surgical ICU admissions were similar in both groups (p = 0.45). CONCLUSIONS: The proportion of ICU admissions greater than or equal to 80 years old did not change over the 13-year study period. Although their mortality was higher, they showed improved survivorship over time, especially in the unplanned ICU admission subgroup. A higher proportion of survivors were discharged to chronic care facilities.

Age Distribution and Clinical Results of Critically Ill Patients above 65-Year-Old in an Aging Society: A Retrospective Cohort Study

“…And it characterized by increased frailty [ 12 , 13 ] and multimorbidity [ 14 , 15 ]. In several countries, including Australia and New Zealand, studies [ 8 , 16 ] have shown that the proportion of patients aged 80 and older admitted to intensive care units (ICUs) is increasing year on year. Similar trends are being observed in the United States [ 17 ], where the average age of older ICU patients is increasing, as are the number of disabilities and multimorbidity cases.…”

Easing Suffering for ICU Patients and Their Families: Evidence and Opportunities for Primary and Specialty Palliative Care in the ICU

“…3 Although ICU mortality is improving, many survivors are discharged to subacute or long-term care settings rather than home, especially among older populations. 4,5 Even among survivors, short-, intermediate-and long-term outcomes such as hospital readmission and mortality remain discouragingly high, especially among medical ICU survivors. [6][7][8] Compared with non-ICU hospital survivors, 5-year readmission was 65% among ICU survivors (vs 49.7% non-ICU) with the majority of readmissions occurring in the first year after discharge.…”