Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU

Lange, Dylan W. de; Brinkman, Sylvia; Boumendil, Ariane; Morandi, Alessandro; Andersen, Finn H.; Artigas, Antonio; Bertolini, Guido; Cecconi, Maurizio; Christensen, Steffen; Faraldi, Loredana; Fjølner, Jesper; Jung, Christian; Marsh, Brian; Moreno, Rui P.; Oeyen, Sandra; Öhman, Christina Agvald; Pinto, Bernardo Bollen; Smet, Anne Marie G. A. de; Soliman, Ivo W.; Szczeklik, Wojciech; Valentin, Andreas; Watson, Ximena; Zafeiridis, Tilemachos; Guidet, Bertrand

doi:10.1111/jgs.15888

Cited by 34 publications

(22 citation statements)

References 31 publications

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“…No changes in decision-making were seen regarding patient age, cost of care and patient social status. Even though high age is a well-known risk factor for poor survival after an acute illness, age alone is not seen as an acceptable reason for withholding or withdrawing lifesustaining treatment in acute care setting [67,68]. A big challenge with the aging population involves learning to identify elderly patients who still benefit from intensive care procedures.…”

Section: Discussionmentioning

confidence: 99%

Physicians’ decreased tendency to choose palliative care for patients with advanced dementia between 1999 and 2015

et al. 2021

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Background Physicians’ decision-making for seriously ill patients with advanced dementia is of high importance, especially as the prevalence of dementia is rising rapidly, and includes many challenging ethical, medical and juridical aspects. We assessed the change in this decision-making over 16 years (from 1999 to 2015) and several background factors influencing physicians’ decision. Methods A postal survey including a hypothetical patient-scenario representing a patient with an advanced dementia and a life-threatening gastrointestinal bleeding was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. The target groups were general practitioners (GPs), surgeons, internists and oncologists. The respondents were asked to choose between several life-prolonging and palliative care approaches. The influence of physicians’ background factors and attitudes on their decision were assessed. Results The response rate was 56%. A palliative care approach was chosen by 57 and 50% of the physicians in 1999 and 2015, respectively (p = 0.01). This change was statistically significant among GPs (50 vs 40%, p = 0.018) and oncologists (77 vs 56%, p = 0.011). GPs chose a palliative care approach less often than other responders in both years (50 vs. 63% in 1999 and 40 vs. 56% in 2015, p < 0.001). In logistic regression analysis, responding in 2015 and being a GP remained explanatory factors for a lower tendency to choose palliative care. The impact of family’s benefit on the decision-making decreased, whereas the influence of the patient’s benefit and ethical values as well as the patient’s or physician’s legal protection increased from 1999 to 2015. Conclusions Physicians chose a palliative care approach for a patient with advanced dementia and life-threatening bleeding less often in 2015 than in 1999. Specialty, attitudes and other background factors influenced significantly physician decision-making. Education on the identification and palliative care of the patients with late-stage dementia are needed to make these decisions more consistent.

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Section: Discussionmentioning

confidence: 99%

Physicians’ decreased tendency to choose palliative care for patients with advanced dementia between 1999 and 2015

et al. 2021

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“…Traditional severity scores are not intended for individual use in triage, and are validated for a general intensive population, not for the elderly people. Based on data from VIP1, an attempt was made to create a model for predicting death within 30 days after admission to the intensive care unit 33 . Even after including many variables in the model, it was not possible to accurately predict who will die within 30 days.…”

Section: Discussionmentioning

confidence: 99%

Frailty and survival in elderly intensive care patients in Norway

Andersen

Haaland

Klepstad

2021

Acta Anaesthesiol Scand

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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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“…In our study, the mortality rate was 40% (n = 2389), whereas other studies noted it to be 37% (16) and 52.3% (6) in patients in the critical intensive care. In a prospective study conducted on patients in the ICU with an average age of 84 years, the 30-day mortality rate was 41.9% (17). In another study, the 30-day mortality was determined to be 43.7% (15).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Mortality Outcomes of Three Different Geriatric Age Groups in the Intensive Care Unit: 10-Year Retrospective Analysis

Görgülü¹,

Koşar²

2020

tjgeri

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In addition to bringing many physiological changes with it, aging is a period in which morbidity and mortality rates increase due to the increase in the incidence of chronic diseases and malignant diseases. The aim of this study was to determine the prevalence of conditions requiring intensive care and the mortality incidence based on geriatric age groups followed-up in the intensive care unit. Materials and Method: Three different geriatric age groups were formed out of the 65 years old and older patients (n=5932) included in the study as young old (65-74 years), middle old (75-84 years) and oldest old (85 years and older). In each group, disease prevalence and mortality rate by diagnostic groups were analysed. Results: The resulting diagnostic groups were found to be at different rates in different age groups (p = 0.01 p <0.05). Malignancy was high in young elderly patients (p = 0.01 p <0.05), while cardiovascular diseases were higher in other groups (p = 0.01 p<0.05). Patients admitted to the intensive care unit with cardiac arrest had the highest mortality rate (p = 0.01 p<0.05). Conclusion: Geriatric patients constitute an important part of intensive care patients, therefore the mortality rate is high. In all three groups, 30-day mortality results were highest in patients with cardiac arrest followed by sepsis and cardiovascular diseases, respectively.

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Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU

Cited by 34 publications

References 31 publications

Physicians’ decreased tendency to choose palliative care for patients with advanced dementia between 1999 and 2015

Physicians’ decreased tendency to choose palliative care for patients with advanced dementia between 1999 and 2015

Frailty and survival in elderly intensive care patients in Norway

Diagnosis and Mortality Outcomes of Three Different Geriatric Age Groups in the Intensive Care Unit: 10-Year Retrospective Analysis

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