Determinants of outcome in elderly patients admitted to the intensive care unit

Vosylius, Saulius; Šipylaitė, Jūratė; Ivaškevičius, Juozas

doi:10.1093/ageing/afi037

Cited by 132 publications

(130 citation statements)

References 22 publications

Supporting

Mentioning

105

Contrasting

Unclassified

Order By: Relevance

“…(19) The main complications observed during ICU stay in the present study were anemia, respiratory failure, coma, sepsis, metabolic acidosis, hypertension, acute kidney injury, coagulation disturbances and hypotension. We did not observed patients with uremia because of prompt initiation of dialysis in the appropriate cases.…”

Section: Discussionmentioning

confidence: 55%

Fatores de risco para óbito em pacientes idosos gravemente enfermos

Alves¹,

Júnior²,

Lima³

et al. 2010

Rev. bras. ter. intensiva

View full text Add to dashboard Cite

Fatores de risco para óbito em pacientes idosos gravemente enfermos INTRODUCTIONThe elderly population is increasing all over the world. It is estimated that the population older than 80 years-old will increase 40% between 1995 and 2015.(1) The US census estimates that by 2050, approximately 20.1% (88.5 million) of the US population will be older than 65, and 4.3% (19.04 million) will be older than 85 years of age.(2) The consequence is an increase in chronic diseases and corresponding expectations of eventual decline in function. (3,4) Many investigators have reported rising numbers of elderly patients admitted to intensive care units (ICUs). (5)(6)(7) In the last years some studies regarding mortality in elderly patients have ABSTRACT Background:The elderly population is increasing all over the world. The need of intensive care by the elderly is also increasing. There is a lack of studies investigating the risk factors for death among critically ill elderly patients. This study aims to investigate the factors associated with death in a population of critically ill elderly patients admitted to an intensive care unit in Brazil.Methods: This is a retrospective cohort study including all elderly patients (>60 years) admitted to an intensive care unit in Fortaleza, Brazil, from January to December 2007. A comparison between survivors and nonsurvivors was done and the risk factors for death were investigated through univariate and multivariate analysis.Results: A total of 84 patients were included, with an average age of 73 ± 7.6 years; 59% were female. Mortality was 62.8%. The main cause

show abstract

Section: Discussionmentioning

confidence: 55%

Fatores de risco para óbito em pacientes idosos gravemente enfermos

Alves¹,

Júnior²,

Lima³

et al. 2010

Rev. bras. ter. intensiva

View full text Add to dashboard Cite

show abstract

“…The principal reason for ICU admission in very elderly subjects was pneumonia (16%). The median SAPS II and APACHE II scores on ICU admission were 37 (IQR, 28 -50) and 14 (IQR, [11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Age-specific Rates Of Admission and Mortalitymentioning

confidence: 99%

“…1 Although age is thought of as a strong prognostic factor for critical care, some studies have included other predictive factors such as severity of illness, reason for admission, and underlying condition as well. 1,[5][6][7][8][9][10][11] However, in elderly patients admitted to the ICU, life-sustaining treatments are more often withdrawn and invasive treatments tend to be avoided. 12,13 Thus, analysis of the outcomes and prognoses of very elderly patients admitted to the ICU is important in terms of the provision of information to the medical team, patients, and families for advanced care planning and decision-making.…”

Section: Introductionmentioning

confidence: 99%

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

et al. 2014

View full text Add to dashboard Cite

BACKGROUND:We evaluated the clinical characteristics and factors associated with mortality in very elderly patients > 90 y of age admitted to the ICU. METHODS: We evaluated age-specific rates of admission and mortality in 16,935 subjects > 18 y old and retrospectively analyzed the clinical data of 155 (0.92%) subjects > 90 y old admitted to the ICU from January 2003 to July 2012. The clinical mortality index was defined as the ICU mortality rate associated with clinical risk factors including poor nutrition, do not resuscitate (DNR) order, pneumonia, chronic renal failure, cancer, mechanical ventilation, use of a vasopressor, and admission from a ward. RESULTS: The mortality rate of ICU subjects > 90 y of age was 32.3%. A Cox's regression hazard model revealed that high glucose (P ‫؍‬ .006), poor nutrition (P ‫؍‬ .001), high Simplified Acute Physiology Scoring II scores (P < .001), DNR order (P ‫؍‬ .002), and vasopressor treatment (P ‫؍‬ .03) were independent predictive factors of mortality in subjects > 90 y of age admitted to the ICU. An increasing number of clinical risk factors was associated with progressively higher mortality rates. All subjects with more than 5 risk factors died. CONCLUSIONS: The very elderly subjects (> 90 y) admitted to the ICU had a higher mortality rate compared with subjects of other ages. High Simplified Acute Physiology Scoring II scores, poor nutritional status, high glucose, use of vasopressors, and DNR orders should be considered as important predictors of mortality in very elderly ICU patients. The level of ICU treatment should be carefully considered in very elderly patients presenting with 5 or more risk factors.

show abstract

“…9 Acute care environments that don't address the medical and functional needs of older patients are dangerous places for these adults, who are vulnerable to higher morbidity and mortality than younger patients. 10 -Acute care for elders‖ units are dedicated hospital-based areas designed with special attention to the needs of older patients, including appropriate physical environments and staff education. Hospital-based or freestanding subacute units provide interventions to avoid or shorten expensive stays and are usually dedicated to a specific disease process, such as dementia.…”

Section: Shortcomings Of Acute Care Settingsmentioning

confidence: 99%

“…Another innovation to improve quality of care to geriatric patients is the hospital-based geriatric nurse case leader. 10 However, most hospital units don't have the luxury of offering these innovations.…”

Section: Shortcomings Of Acute Care Settingsmentioning

confidence: 99%

Recognize the many facets of gerontological nursing

Barba¹,

Tesh²,

Kohlenberg³

2007

Nursing Management (Springhouse)

View full text Add to dashboard Cite

Article:Fact: Older adults influence hospital environments. This patient population is now the predominant recipient of services in all healthcare settings-50% of hospital patients, 70% of home care patients, and 90% of ambulatory patients.1 Patients over age 65 account for 48% of critical care unit admissions and more than 50% of critical care days.2 Hospitalized older patients use more resources and have higher charges and longer stays, accounting for up to 70% of cost outliers. 3,4 Nurse leaders of hospital units with high percentages of patients over 65 years of age face numerous challenges, including personnel, organizational structure, and regulatory requirements. There's little information, however, on management issues in hospital units that aren't designated specifically for older adults. Unique nursing needsHospital units that consider children their -core business‖ often support, and sometimes require, national certification for registered nurses in pediatric specialties; ensure adherence to national scopes and standards for pediatric nursing care; and meet Magnet or Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements for staff competence in the care of pediatric patients. Yet when older adults are the -core business‖ of a hospital unit, there's usually no requirement for gerontological/geriatric certification for nursing staff, no adherence to national scopes and standards for care of older adults, and no consideration of Magnet or JCAHO requirements for staff competence in the care of older adults (-age-specific competencies‖). 5 Nevertheless, hospitalized older adult patients have unique nursing needs. Admission to an acute care hospital doesn't necessarily improve older patients' health status; often the goal of treatment for geriatric patients is to maintain function or slow the decline of functional consequences of chronic health problems, rather than restore older patients to previous levels of health or better. This difference is significant in the philosophy of care for nursing staff who are accustomed to -making somebody well.‖ Older patients also frequently present with ambiguous illness symptoms. For example, an older person with pneumonia or urinary tract infection may not have the elevated temperature or changes in laboratory values that would be seen in younger adult patients. Because of age-related changes in the immune system, the only symptom of infection may be a change in mental status.In addition to acute problems that prompt hospitalization, older patients are often dealing with chronic health problems such as arthritis, diabetes, hearing and vision problems, hypertension, and cardiovascular disease. Comorbid conditions can complicate treatment and recovery, increasing length of stay and leading to hospital charges that fall outside the established payment scale. Further, because of age-related physiological changes, older patients have fewer energy reserves and unpredictable responses to medical and nursing interventions. They're at greater risk fo...

show abstract

Determinants of outcome in elderly patients admitted to the intensive care unit

Abstract: Morbidity and mortality in elderly patients admitted to the ICU are higher than in younger patients. The most important factors independently associated with the highest risk of death are the severity of illness, impaired level of consciousness and infection.

Cited by 132 publications

References 22 publications

Fatores de risco para óbito em pacientes idosos gravemente enfermos

Fatores de risco para óbito em pacientes idosos gravemente enfermos

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

Recognize the many facets of gerontological nursing

Contact Info

Product

Resources

About