Short-term outcomes in older intensive care unit patients with dementia*

Pisani, Margaret A.; Redlich, Carrie A.; McNicoll, Lynn; Ely, E. Wesley; Friedkin, Rebecca J.; Inouye, Sharon K.

doi:10.1097/01.ccm.0000165558.83676.48

Cited by 51 publications

(39 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite patient willingness to undergo aggressive treatments, recent studies have demonstrated that the presence of a determined code status (DNR/DNI vs. full code) affects physician behavior toward aggressiveness of care including recommending ICU admission (27). Consistent with our findings, Pisani et al (28) found that in patients with advanced dementia, the presence of a DNR/ DNI code status did not affect mortality and a change to less aggressive care was associated with increased ICU and hospital mortality.…”

Section: Discussionsupporting

confidence: 92%

Nursing home patients in the intensive care unit: Risk factors for mortality

Mattison

Rudolph²,

Kiely³

et al. 2006

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 92%

Nursing home patients in the intensive care unit: Risk factors for mortality

Mattison

Rudolph²,

Kiely³

et al. 2006

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Chronically, CD manifests as difficulties with memory, attention, executive function, processing speed, spatial abilities, and general intelligence, which may persist long after ICU discharge. Older patients are particularly susceptible to both acute and chronic cognitive dysfunction, especially when there is preexisting dementia or mild cognitive impairment (71,72). Yet even without baseline dementia, older adults have a greater likelihood of cognitive decline after hospitalization than those who were not hospitalized (73).…”

Section: Critical Illness-associated Cognitive Dysfunctionmentioning

confidence: 99%

Toward an Integrated Research Agenda for Critical Illness in Aging

Milbrandt¹,

Eldadah²,

Nayfield³

et al. 2010

Am J Respir Crit Care Med

View full text Add to dashboard Cite

Aging brings an increased predisposition to critical illness. Patients older than 65 years of age account for approximately half of all intensive care unit (ICU) admissions in the United States, a proportion that is expected to increase considerably with the aging of the population. Emerging research suggests that elderly survivors of intensive care suffer significant long-term sequelae, including accelerated age-related functional decline. Existing evidence-based interventions are frequently underused and their efficacy untested in older subjects. Improving ICU outcomes in the elderly will require not only better methods for translating sound science into improved ICU practice but also an enhanced understanding of the underlying molecular, physiological, and pathophysiological interactions of critical illness with the aging process itself. Yet, significant barriers to research for critical illness in aging exist. We review the state of knowledge and identify gaps in knowledge, research opportunities, and barriers to research, with the goal of promoting an integrated research agenda for critical illness in aging.

show abstract

“…Delirium occurs in approximately 20% to 30% of general medical inpatients, 1,2 10% to 48% of patients with stroke, 3 70% to 83% of patients in the intensive care unit (ICU), 4,5 and 80% of patients nearing end of life. 6 The negative consequences of delirium are far-reaching, impacting patient and system-level hospital outcomes.…”

Section: Introductionmentioning

confidence: 99%

Improving Delirium Care

Kostas

Zimmerman

Rudolph

2013

The Neurohospitalist

View full text Add to dashboard Cite

Delirium is an acute change in awareness and attention and is common, morbid, and costly for patients and health care systems. While hyperactive delirium is easily identifiable, the hypoactive form is more common and carries a higher mortality. Hospital systems to address delirium should consist of 3 critical steps. First, hospitals must identify patients who develop or are at intermediate or high risk for delirium. Delirium risk may be assessed using known patient-based and illness-based risk factors, including preexisting cognitive impairment. Delirium diagnosis remains a clinical diagnosis that requires a clinical assessment that can be structured using diagnostic criteria. Hospital systems may be useful to efficiently allocate delirium resources to prevent and manage delirium. Second, it is crucial to develop a systematic approach to prevent delirium using multimodal nonpharmacologic delirium prevention methods and to monitor all high-risk patients for its occurrence. Tools such as the modified Richmond Agitation and Sedation Scale can aid in monitoring for changes in mental status that could indicate the development of delirium. Third, hospital systems can utilize established methods to assess and manage delirium in a standardized fashion. The key lies in addressing the underlying cause/causes of delirium, which often involve medical conditions or medications. With a sustained commitment, standardized efforts to identify and prevent delirium can mitigate the long-term morbidity associated with this acute change. In the face of changes in health care funding, delirium serves as an example of a syndrome where care coordination can improve short-term and long-term costs.

show abstract

Short-term outcomes in older intensive care unit patients with dementia*

Cited by 51 publications

References 43 publications

Nursing home patients in the intensive care unit: Risk factors for mortality

Nursing home patients in the intensive care unit: Risk factors for mortality

Toward an Integrated Research Agenda for Critical Illness in Aging

Improving Delirium Care

Contact Info

Product

Resources

About