ICU admission characteristics and mortality rates among elderly and very elderly patients

Fuchs, Lior; Chronaki, Catherine; Park, Shinhyuk; Novack, Victor; Baumfeld, Yael; Scott, Daniel; McLennan, Stuart; Talmor, Daniel; Celi, Leo Anthony

doi:10.1007/s00134-012-2629-6

Cited by 217 publications

(223 citation statements)

References 30 publications

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“…Most studies about outcomes in very elderly subjects in the ICU were evaluated with people 80 or 85 y of age and older. 1,[7][8][9][10]23,24 In a large cohort from Australia and New Zealand, 1 the cumulative proportion of ICU admissions and the ICU mortality rates of subjects Ն 90 y old were 0.88% and 12.0% lower than ours. The various admission and mortality rates found for very elderly subjects of other studies are probably attributable to differences in study design, geographic/cultural variations, and differences in the study populations, including the definition of very elderly subjects, severity of the acute illness, and treatment intensity.…”

Section: Discussionmentioning

confidence: 68%

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

et al. 2014

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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.

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Section: Discussionmentioning

confidence: 68%

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

et al. 2014

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“…The SOFA score increased with increasing age and was found to increase with mortality. This study claimed that in patients aged>75 years, mortality might be higher than expected; the need for special care for these patients was emphasized (12).…”

Section: Discussionmentioning

confidence: 91%

A Study on Physicians Perspectives on Elder Abuse and Neglect

ERASLAN¹

2018

tjgeri

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Introduction:In elderly patients with clinically diagnosed sepsis, we investigated the performance of quick sepsis-associated organ failure assessment in admission to the mortality and intensive care unit and compared its performance with acute physiology and chronic health assessment, assessing systemic inflammatory response syndrome, sepsis-related organ failure.Materials and Method: From February 2016 to February 2017, we retrospectively reviewed 92 elderly patients (≥65 years of age) who were clinically diagnosed with sepsis in the intensive care unit. We compared the performance of organ failure assessment associated with sepsis, acute physiology and chronic health assessment II, systemic inflammatory response syndrome, and quick sepsis related with organ failure assessment, foreseeing a 28-day mortality in the intensive care unit.Results: The scores of organ failure assessment associated with quick sepsis were 1 in 6.5% (n=6), 2 in 30.4% (n=28) and 3 in 63% (n=58) Mean sepsis-related organ failure rating score was 9.2±3.0, mean systemic inflammatory response syndrome score was 2.6±0.6, and acute physiology and chronic health assessment score II was 25.4±7.2. There was a statistically significant difference (p<0.001) between patients with mortality rates of> 7 and <7 and 81% and 31% respectively in patients with organ failure assessment score associated with sepsis.Conclusion: Quick sepsis related organ failure assessment may be a better alternative in determining mortality risk, since it can be easily applied when compared to sepsis related organ failure assessment in geriatric patients.Keywords: Organ dysfunction scores; Sepsis; Geriatrics; Critical careGiriş: Klinik olarak tanısı konmuş sepsis olan yaşlı hastalarda mortalite ve yoğun bakım ünitesine kabul etmede hızlı sepsis ile ilişkili organ yetmezliği değerlendirmesinin performansını araştırdık ve performansını sistemik inflamatuar yanıt sendromu, sepsis ile ilişkili organ yetmezliği değerlendirmesi ve akut fizyoloji ve kronik sağlık değerlendirmesi ile karşılaştırdık.Gereç ve Yöntem: Şubat 2016'dan Şubat 2017'ye kadar, yoğun bakım ünitesinde klinik olarak sepsis tanısı alan 92 yaşlı (≥65 yaş) hastayı retrospektif olarak inceledik. Yoğun bakım ünitesinde 28 günlük mortaliteyi öngörmede sepsis ile ilişkili organ yetmezliği değerlendirmesi, akut fizyoloji ve kronik sağlık değerlendirmesi II, sistemik inflamatuar yanıt sendromu ve hızlı sepsis ile ilişkili organ yetmezliği değerlendirmesinin performansını karşılaştırdık.Bulgular: Hızlı sepsis ile ilişkili organ yetmezliği değerlendirmesi skorları %6.5 (n=6) hastada 1, %30.4 (n=28) hastada 2 ve %63 (n=58) hastada 3 idi. Ortalama sepsis ile ilişkili organ yetmezliği değerlendirmesi skoru 9.2±3.0, ortalama sistemik inflamatuar yanıt sendromu skoru 2.6±0.6 ve akut fizyoloji ve kronik sağlık değerlendirmesi II skoru 25.4±7.2 idi. Ölüm oranları >7 and <7 sepsis ile ilişkili organ yetmezliği değerlendirmesi skoru olan hastalarda sırasıyla %81 ve %31 olup, aralarında istatistiksel olarak anlamlı bir fark bulunmu...

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“…Several studies have confirmed the very poor long-term prognosis of elderly patients admitted to the ICU [2][3][4][5][6][7][8][9] (Table 1). Importantly, factors such as an atypical presentation with delayed diagnosis and treatment, suboptimal management (because guidelines are not tailored for an elderly population), lower physiologic reserve, immuno-senescence coupled with an inadequate immune response, more frequent and earlier treatment limitations, and finally inadequate discharge policies (location, timing) may account for or at least contribute to excess mortality.…”

Section: Available Evidencementioning

confidence: 83%

“Are you sure it’s about ‘age’?”

Rusínová¹,

Guidet

2013

Intensive Care Med

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Ninety-seven percent of elderly patients (over 85 years) treated in the ICU for circulatory failure die within 12 months of the life-threatening episode. The ICU survival rate is 33 % and about 23 % of patients are discharged from hospital, but only 8 % are alive at 6 months and only 3 % at 1 year.One cannot help but feel uncomfortable and discouraged after reading the results of a secondary analysis of data from a large trial comparing the effects of dopamine and noradrenaline on ICU outcomes by Biston et al. [1], in this issue of Intensive Care Medicine.What are the implications of taking into consideration the very uncertain prognosis associated with elderly patients treated in the ICU for circulatory failure? What is the appropriate clinical algorithm and how should a physician respond the next time a call comes in from an emergency department about an 85-year-old patient in shock? Researcher vs. attending physician bias and potential conflict of interestWhen a study finds a 3 % survival and 97 % mortality rate, then the 3 % are often associated with an 'opportunity for improvement' and the 97 % is presented as a 'challenge.' Although it is an acceptable and motivating proposition for a researcher, the same terms 'opportunity' and 'challenge' can be viewed as unrealistic and misleading expressions relative to the real world of clinical decision-making and complex and unique patient-physician relationships.

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ICU admission characteristics and mortality rates among elderly and very elderly patients

Cited by 217 publications

References 30 publications

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

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

A Study on Physicians Perspectives on Elder Abuse and Neglect

“Are you sure it’s about ‘age’?”

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