The Very Elderly Admitted to ICU

Heyland, Daren K.; Cook, Deborah J.; Bagshaw, Sean M.; Garland, Allan; Stelfox, Henry T.; Mehta, Sangeeta; Dodek, Peter; Kutsogiannis, Jim; Burns, Karen E. A.; Muscedere, John; Turgeon, Alexis F.; Fowler, Rob; Jiang, Xuran; Day, Andrew G.

doi:10.1097/ccm.0000000000001024

Cited by 139 publications

(96 citation statements)

References 17 publications

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“…In our prospective, observational cohort of very elderly patients admitted to ICUs in Canada, not only was hospital and 12-month mortality high [11], but surviving individuals had a low probability of returning to baseline physical function [12]. Other studies have corroborated the findings of poor short- and long-term outcomes in this patient population [13–16].…”

Section: Introductionmentioning

confidence: 80%

“…As described in previous reports [11, 12], the data source for this study was a prospective cohort of patients 80 years of age or older admitted to 22 Canadian ICUs between September 2009 and January 2013. Briefly, all eligible patients whose hospital records were abstracted, based on research coordinator availability, were included in an unselected “hospital cohort”, which captured patient demographics and clinical outcomes for the index hospital admission.…”

Section: Methodsmentioning

confidence: 99%

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Cost analysis of the very elderly admitted to intensive care units

et al. 2017

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BackgroundVery elderly patients are often admitted to intensive care units (ICUs) despite poor outcomes and frequent preference to avoid unnecessary prolongation of life. We sought to determine the cost of ICU admission for the very elderly and the factors influencing this cost.MethodsThis prospective, observational cohort study included patients ≥80 years old admitted to 22 Canadian ICUs from 2009 to 2013. A subset of consenting individuals comprised a longitudinal cohort followed over 12 months. Costs were calculated from ICU length of stay and unit costs for ICU admission from a Canadian academic hospital. A generalized linear model was employed to identify cost-predictive variables.ResultsIn total, 1671 patients were included; 610 were enrolled in the longitudinal cohort. The average age was 85 years; median ICU length of stay was 4 days. Mortality was 35% (585/1671) in hospital and 41% (253/610) at 12 months. The average cost of ICU admission per patient was $31,679 ± 65,867. Estimated ICU costs were $48,744 per survivor to discharge and $61,783 per survivor at 1 year. For both decedents and survivors, preference for comfort measures over life support was an independent predictor for lower cost (P < 0.01).ConclusionsConsidering the poor clinical outcomes, and that many ICU admissions may be undesired by very elderly patients, ICU costs in this population are substantial. Our finding that a preference for comfort care predicted a lower cost independent of mortality reinforces the importance of early goals of care discussions to avoid both undesired and potentially non-beneficial interventions, consequently reducing costs.Trial registrationClinicalTrials.gov, NCT01293708. Registered on 10 February 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1689-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Cost analysis of the very elderly admitted to intensive care units

et al. 2017

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“…The literature documents that organ support is lower and shorter in elderly compared to matched younger patients [5]. Median ICU length of stay (LOS), excluding elective post-operative admissions, is limited to 2-6 days for VOPs [6][7][8]. According to data from the Norwegian Intensive Care Registry from 2006 to 2009, significantly fewer VOPs were given ventilator support (40 vs 56%), and the median time on the mechanical ventilator (MV) and LOS on the ICU were shorter [9].…”

Section: Icu Interventions and Length Of Staymentioning

confidence: 99%

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

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The "very old intensive care patients" (abbreviated to VOPs; greater than 80 years old) are probably the fastest expanding subgroup of all intensive care unit (ICU) patients. Up until recently most ICU physicians have been reluctant to admit these VOPs. The general consensus was that there was little survival to gain and the incremental life expectancy of ICU admission was considered too small. Several publications have questioned this belief, but others have confirmed the poor long-term mortality rates in VOPs. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making and improved prediction models are also needed for this particular patient group. Here, an expert panel proposes a research agenda for VOPs for the coming years.

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“…This generates discussion about the real benefit of intensive care for very elderly patients. A Canadian study of 1,670 patients aged 80 years or older showed that one-third of these patients died in hospital receiving aggressive interventions, even after a prolonged ICU stay (23) .…”

Section: Discussionmentioning

confidence: 99%

Fatores preditores de óbito em Unidade de Terapia Intensiva: contribuição para a abordagem paliativista

Gulini

Nascimento

Moritz

et al. 2018

Rev. esc. enferm. USP

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RESUMO Objetivo Identificar preditores de óbito na Unidade de Terapia Intensiva e relacionar pacientes elegíveis para cuidados paliativos preferenciais. Método Coorte prospectivo que avaliou pacientes internados por mais de 24 horas, subdivididos em G1 (pacientes que morreram) e G2 (pacientes com alta hospitalar). Para a identificação dos fatores preditores para o desfecho óbito, foi feita ao médico intensivista a “pergunta-surpresa” e foram coletados dados clínico-demográficos dos pacientes. Os dados foram analisados por estatística descritiva/inferencial (significante p<0,05). Resultados Foram avaliados 170 pacientes. A resposta negativa à “pergunta-surpresa” foi relacionada ao desfecho óbito. Houve maior possibilidade de óbito (p<0,05) entre os pacientes mais velhos, mais frágeis, com menor funcionalidade, com insuficiências cardíaca e/ou renal crônicas ou insulto neurológico agudo não traumático, com falência multiorgânica por mais de 5 dias, internados por mais tempo. Conclusão Preditores de óbito foram relacionados à avaliação subjetiva do médico, à condição clínica do paciente, às doenças de base, à gravidade da doença aguda e à evolução da doença crítica. Sugere-se que pacientes com dois ou mais critérios preditores recebam cuidados paliativos preferenciais.

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The Very Elderly Admitted to ICU

Abstract: In this multicenter study, one third of very elderly ICU patients died in hospital, many after a prolonged ICU stay while continuing to receive aggressive life-sustaining interventions. These findings raise questions about the use of critical care at the end of life for the very elderly.

Cited by 139 publications

References 17 publications

Cost analysis of the very elderly admitted to intensive care units

Cost analysis of the very elderly admitted to intensive care units

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Fatores preditores de óbito em Unidade de Terapia Intensiva: contribuição para a abordagem paliativista

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