Intermediate geriatric care in Geneva: A 10-year experience

Weiss, Lucien; C, Graf; Herrmann, Françoís; Salomon, R.; Perrenoud, Jean‐Jacques

doi:10.1016/j.eurger.2012.07.457

Cited by 3 publications

(7 citation statements)

References 7 publications

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“…A 4-bed of geriatric IMCU was created 20 years ago in a dedicated center for elderly patients. This IMCU admits about 400 patients per year, with a mean 4.5-day length of stay [16].…”

Section: Settingmentioning

confidence: 99%

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit

D'Andrea

Peillet²,

Fassier³

et al. 2020

BMC Geriatr

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Background Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU). Methods A monocentric, retrospective, observational study of all patients aged ≥75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables. Results A total of 345 patients were included (56% female, mean age 85 +/− 6.5 years). Mean FIM score was 66 +/− 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68 and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores. Conclusions In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.

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“…A 4-bed of geriatric IMCU was created 20 years ago in a dedicated center for elderly patients. This IMCU admits about 400 patients per year, with a mean 4.5-day length of stay [16].…”

Section: Settingmentioning

confidence: 99%

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit

D'Andrea

Peillet²,

Fassier³

et al. 2020

BMC Geriatr

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“…Dedicated geriatric beds were described in two pre-post intervention cohort studies ( 17 , 20 ) and three descriptive cohort studies without comparator ( 23 , 24 , 28 ). The five studies were in step-down units.…”

Section: Resultsmentioning

confidence: 99%

“…Four (21%) articles were pre-post intervention cohort studies (17)(18)(19)(20), eight (42%) were descriptive cohort studies without a comparator group (21)(22)(23)(24)(25)(26)(27)(28), and seven (37%) were editorials, reviews, and opinion pieces (29-35) (Supplementary Tables 1 and 2, http://links. lww.com/CCX/A969).…”

Section: Description Of Articlesmentioning

confidence: 99%

“…Four different models of care were identified (Table 1): dedicated geriatric beds (17,20,23,24,28,33), geriatric assessment by a geriatrician (18,19,21,27), geriatric assessment without geriatrician (22,29,34,35), and other approaches. Other approaches included checklists, bundles of care, and incremental educational strategies (25,26,(30)(31)(32).…”

Section: Description Of Models Of Carementioning

confidence: 99%

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Models of Care in Geriatric Intensive Care—A Scoping Review on the Optimal Structure of Care for Critically Ill Older Adults Admitted in an ICU

Wissanji

Forget

Muscedere

et al. 2022

Critical Care Explorations

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OBJECTIVE: A growing proportion of critically ill patients admitted in ICUs are older adults. The need for improving care provided to older adults in critical care settings to optimize functional status and quality of life for survivors is acknowledged, but the optimal model of care remains unknown. We aimed to identify and describe reported models of care. DATA SOURCES: We conducted a scoping review on critically ill older adults hospitalized in the ICU. Medline (PubMed), Embase (OvidSP), Cumulative Index to Nursing and Allied Health Literature (Ebsco), and Web of Science (Clarivate) were searched from inception to May 5, 2020. STUDY SELECTION: We included original articles, published abstracts, review articles, editorials, and commentaries describing or discussing the implementation of geriatric-based models of care in critical care, step-down units, and trauma centers. The organization of care had to be described. Articles only discussing geriatric syndromes and specific interventions were not included. DATA EXTRACTION: Full texts of included studies were obtained. We collected publication and study characteristics, structures of care, human resources used, interventions done or proposed, results, and measured outcomes. Data abstraction was done by two investigators and reconciled, and disagreements were resolved by discussion. DATA SYNTHESIS: Our search identified 3,765 articles, and we found 19 reporting on the implementation of geriatric-based models of care in the setting of critical care. Four different models of care were identified: dedicated geriatric beds, geriatric assessment by a geriatrician, geriatric assessment without geriatrician, and a fourth model called “other approaches” including geriatric checklists, bundles of care, and incremental educational strategies. We were unable to assess the superiority of any model due to limited data. CONCLUSIONS: Multiple models have been reported in the literature with varying degrees of resource and labor intensity. More data are required on the impact of these models, their feasibility, and cost-effectiveness.

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“…A 4-bed of geriatric IMCU was created 20 years ago in a dedicated center for elderly patients. This IMCU admits about 400 patients per year, with a mean 4.5-day length of stay (16). were also recorded, when available at the admission of the patients.…”

Section: Settingmentioning

confidence: 99%

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit.

D'Andrea

Peillet²,

Reny³

et al. 2020

Preprint

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Background Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU). Methods A monocentric, retrospective, observational study of all patients aged ≥ 75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables. Results A total of 345 patients were included (56% female, mean age 85 +/- 6.5 years). Mean FIM score was 66 +/- 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68% and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores. Conclusions In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.

show abstract

Intermediate geriatric care in Geneva: A 10-year experience

Cited by 3 publications

References 7 publications

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit

Models of Care in Geriatric Intensive Care—A Scoping Review on the Optimal Structure of Care for Critically Ill Older Adults Admitted in an ICU

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit.

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