Long‐term consequences of pain, anxiety and agitation for critically ill older patients after an intensive care unit stay

Jeitziner, Marie‐Madlen; Hamers, Jan P.H.; Bürgin, Reto; Hantikainen, Virpi; Zwakhalen, Sandra

doi:10.1111/jocn.12801

Cited by 11 publications

(21 citation statements)

References 33 publications

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“…The quality of the studies was mainly fair, 12,18e21,23,24 but good in one 25 and poor in one 22 of the studies. The patient populations were heterogenous comprising trauma, 18,25 medical, 22 cardiovascular, 20,21,23 and surgical 12,19 ICU patients. The follow-up periods for patients varied from 6 months 19e22 to 2 yr. 18 Patient characteristics are presented in Table 2.…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…The response rate varied between 8% and 89%. If there was a control group, it was either a group of patients without pain 12,19 or without a specific disease, 21 a healthy control not treated in the ICU, 20,23 or a population norm. 22…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…21 Carrie and colleagues 25 defined chronic pain as a persistent chest pain requiring regular use of analgesics. One study 18 regarded a score of >4 as significant, whereas two studies 23,24 regarded a score of 1 in Brief Pain Inventory (BPI) as significant. Baumbach and colleagues 20 defined chronic pain as pain with an average intensity of 1 in BPI in the past 4 weeks.…”

Section: Definitionsmentioning

confidence: 99%

“…12,18,19,24,25 Carrie and colleagues 25 also interviewed the patients during a follow-up visit. Other studies used the German pain questionnaire, 21 the numeral rating scale (NRS), 23 and the Pain Scale and Self-Efficacy Questionnaire (PSEQ) 22 to assess the frequency, intensity, and location of pain.…”

Section: Pain Evaluationmentioning

confidence: 99%

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Persistent pain in intensive care survivors: a systematic review

Mäkinen

Bäcklund

Liisanantti

et al. 2020

British Journal of Anaesthesia

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Background: According to earlier studies where the main aim has been quality of life, there is growing evidence of increased levels of persistent pain in survivors of critical illness. The cause of admission and several factors during intensive care may have associated risk factors for pain persistence. This systematic review aims to determine the incidence or prevalence of persistent pain after critical illness and to identify risk factors for it. Methods: Six databases were searched, and eventually nine studies were included in the final systematic process. The validity of observational and cross-sectional studies was analysed using the National Institute of Health 'Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies'. Results: The incidence of persistent pain after intensive care varied from 28% to 77%. Risk factors for persistent pain were acute pain at discharge from ICU, higher thoracic trauma score, surgery, pre-existing pain, organ failure, longer length of ventilator or hospital stay, and sepsis. No difference in incidence between medical and surgical patients was found. Conclusions: New systematic, observational studies are warranted to identify persistent pain-related factors in intensive care to improve pain management protocols and thereby diminish the risk of persistent pain after ICU stay.

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Section: Characteristics Of the Studiesmentioning

confidence: 99%

Section: Characteristics Of the Studiesmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

Section: Pain Evaluationmentioning

confidence: 99%

See 2 more Smart Citations

Persistent pain in intensive care survivors: a systematic review

Mäkinen

Bäcklund

Liisanantti

et al. 2020

British Journal of Anaesthesia

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“…This suggested that for elderly ICU survivors, mental health questionnaire items were relatively unaffected. The small literature on older adults also suggests relatively low rates of anxiety 48 and depressive disorders 49 50 , although potentially high rates of post-traumatic stress. 51 Together with previous research, which found that elderly people typically value their psychosocial wellbeing above their physical needs 52 our results highlight the importance of caution with assumptions on age as a determinant of poor quality of life following ICU.…”

Section: Strengths In Relation To the Literaturementioning

confidence: 99%

Quality of Life in elderly ICU survivors: A Rapid Systematic Review and Meta-Analysis of Cohort Studies

Ariyo

Canestrini

David

et al. 2020

Preprint

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BACKGROUND The influence of age upon intensive care unit (ICU) decision-making is complex and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making we explored patient-assessed quality of life (QoL) in ICU survivors. METHODS We conducted a rapid database search of cohort studies published between January 2000 to April 2020, of elderly patients admitted to ICUs. We extracted data on self-reported QoL (EQ-5D composite score), study characteristics and demographic and clinical variables. Using a random-effects model, we then compared QoL scores at follow-up to scores either before admission, age-matched population controls or younger ICU survivors. Finally, we conducted follow-up quantitative analyses to explore potential moderators of these effects, and a qualitative synthesis of QoL subscores. A study protocol was registered prospectively on PROSPERO, ID: CRD42020181181. FINDINGS Our database search found 2536 studies and from these we reviewed 376 potentially relevant full texts. 21 of these studies met the inclusion criteria for qualitative synthesis and 18 were also included in the meta-analysis (N= 2090 elderly adults). The follow-up periods ranged between 3-100 months. There was no significant difference in the elderlys QoL scores between one month before ICU and follow-up, or between follow-up and age-matched community controls. QoL in elderly ICU survivors was significantly worse than younger ICU survivors, with a small-to-medium effect size (d= .33 [.10 to .55]). Mortality rates and length of follow up were possible intermediary factors. The qualitative synthesis suggested that any reductions in QoL were primarily due to reductions in physical health, rather than mental health items. INTERPRETATION Overall, elderly ICU patients did not experience significantly impaired QoL at follow up, compared to before ICU or their healthy peers. Elderly patients who survive ICU can be expected to have slightly worse QoL compared to younger patients, especially in the long-term. The results suggest that the proportionality of age as a determinant of (population level) ICU resource allocation should be kept under close review and that subjective QoL outcomes (not only objective survival data) should inform person-centred decision making in elderly ICU patients.

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A scoping review of older patients' health‐related quality of life, recovery and well‐being after intensive care

2023

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AimsIn the present study, we aimed to determine how Health‐Related Quality of Life (HRQoL), recovery (function and capacity in daily life) and well‐being are followed up and characterised in persons ≥65 years of age who were being cared for in an intensive care unit (ICU).DesignA scoping review.MethodsCINAHL, MEDLINE (Ovid) and PsycINFO databases were searched in October 2021. 20 studies met the inclusion criteria. The scoping review followed the principles outlined by Arksey and O'Malley, and the Preferred Reporting Items for Systematic Review and Meta‐analyses (PRISMA) checklist and Joanna Briggs Institute (JBI) framework were used.ResultsResults are presented under five subheadings: Study characteristics, Type of studies, Methods for follow‐up, health‐related quality of life, and Recovery. Time seems to be an important factor regarding HRQoL among older patients being cared for in an ICU, with most elderly survivors perceiving their HRQoL as acceptable after 1 year. Nevertheless, several studies showed patients' willingness to be readmitted to the ICU if necessary, indicating that life is worth fighting for.Patient or Public ContributionDue to the design of the study, this study involves no patient or public contribution.

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Long‐term consequences of pain, anxiety and agitation for critically ill older patients after an intensive care unit stay

Cited by 11 publications

References 33 publications

Persistent pain in intensive care survivors: a systematic review

Persistent pain in intensive care survivors: a systematic review

Quality of Life in elderly ICU survivors: A Rapid Systematic Review and Meta-Analysis of Cohort Studies

A scoping review of older patients' health‐related quality of life, recovery and well‐being after intensive care

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