Construction of an instrument for the prognostic evaluation of elderly persons in intensive care units

Abstract

Objective: To create an instrument for the prognostic evaluation of elderly patients hospitalized in an intensive care unit. Methods: A cohort study, with prospective data collection, which included elderly persons aged 60 years or older, was carried out in the city of João Pessoa, in the state of Paraíba, Brazil. Data collection was performed using an instrument created from a pilot study and the Katz Index. Poisson's regression was used for data analysis. This technique estimates relative risk, retaining variables with p≤0.10 in the instrument, and ensures biological plausibility. The classification of risk of death was performed using quartile analysis, confirmed by the Receiver Operator Characteristic ( ROC) curve. Results: 205 elderly patients with an average age of 74.6 years and a 59% risk of mortality, were included. Of the total sample and based on the scores, 16.6% of elderly persons had a low risk of developing death, 23.9% were at moderate risk, 40% had a high risk, and 19.5% exhibited a very high risk of death. The positive predictive value of the instrument was 77% and the negative value was 67.5%, with a concordance index of 0.78. The cutoff score of the instrument was 9 points or over. The sensitivity was 77.7% and the specificity was 66.7%. Conclusions: The instrument developed may be useful in the identification of elderly people with risk factors who require increased care. The instrument described can therefore be applied in Brazilian intensive care units.

Intercorrências e cuidados a idosos em unidades de terapia intensiva

“…Thus, age alone is not related to the worst prognosis, but other associated factors, such as severity of acute illness, comorbidities and functional status, may contribute to the worst prognosis. 25 It was observed predominance of men in ICU admissions. 10,15-18-21,23-24,26 A longitudinal study on the clinical and laboratory characteristics and clinical outcome of septic and non-septic patients admitted to the ICU showed that the male sex was more associated with admission due to sepsis in this service.…”

“…26 So, men have a higher frequency of hospitalization in these units because they use primary and secondary health care services less frequently. 25 In this context, it is extremely important to implement the lines of action of the National Policy for Comprehensive Care to Men's Health for recognizing that male diseases constitute real public health problems and thus enabling strategies and actions planned for this public so as to reduce morbidity and mortality rates due to preventable causes in this population. This will make it possible to improve quality of life expectancy.…”

“…27 Also, the length of stay of the elderly over six days in the ICU was a risk for unfavorable outcome, considering this variable as a risk factor for worse prognosis among the elderly in ICU. 25 A prospective study carried out for five months in the general ICU of a tertiary hospital showed that the main risk factors associated with death in the elderly were related to their own advanced age, to the evaluation of daily activities, to high glycemia and to the need for invasive mechanical ventilation on admission to this unit. 13 We verified that, the longer the length of stay in the ICU, the greater the chances of occurring adverse events, since each day of stay increases in 10.0% the chance of a patient suffering from AE.…”

Uso De Protocolos De Nutrição Enteral Em Pacientes Idosos Criticamente Enfermos: Uma Revisão Integrativa

“…Os gerontes, em internamento hospitalar, não raramente demandam leitos em UTI, evoluindo mais facilmente a um estado crítico, o que determina maior tempo de tratamento e, por conseguinte, custos (Pedrosa et al, 2017). Diante de quadros críticos, é de extrema importância proceder com uma terapia nutricional (TN) eficaz para o paciente idoso, diagnosticando déficits nutricionais e intervindo o mais precocemente possível, a fim de evitar maior degradação nutricional, com a qual se associa piores desfechos, visto que é um grupo mais suscetível.…”

The association between modified nutrition risk in critically ill score and mortality in geriatric patients

“…There has been an increase in the number of elderly patients who receive therapy in the hospital and intensive care unit due to increase in the elderly population in the community. There has also been an increase in the rate of admission to the hospital, and thereby, to the intensive care unit (1). The course of elderly patients in intensive care differs in various aspects from that of young patients.…”