Understanding and Reducing Disability in Older Adults Following Critical Illness*

Abstract

Objective To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness. Data Sources Review of the literature describing post-critical illness disability in older adults and expert opinion. Results We identified 19 studies evaluating disability outcomes in critically ill patients age 65 years and older. Newly acquired disability in activities of daily living, instrumental activities of daily living and mobility activities was commonplace among older adults who survived a critical illness. Incident dementia and less-severe cognitive impairment was also highly prevalent. Factors related to the acute critical illness, intensive care unit practices such as heavy sedation, physical restraints and immobility as well as aging physiology and coexisting geriatric conditions can combine to result in these poor outcomes. Conclusion Older adults who survive critical illness suffer physical and cognitive declines resulting in disability at greater rates than hospitalized, non-critically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs.

Unplanned early hospital readmission among critical care survivors: a mixed methods study of patients and carers

“…Measures of pre-existing health had greater predictive value than both demographics and measures of ICU illness severity. Some other themes that emerged from our data are known to be prevalent among critical care survivors, such as mobility or functional impairment (from ICU-acquired weakness)31 and psychological problems (especially anxiety, depression, cognitive impairment and post-traumatic stress) 32. Psychological problems, in particular, seemed important to our participants because they magnified the impact of other factors, and because timely access to psychological care was difficult.…”

Postintensive Care Syndrome

“…Almost all of these patients still have weakness years later (1,3). Cognitive impairment occurs in 30-80% of patients and includes problems with memory, processing, planning, problem solving, and visual-spatial awareness (1,3,5). These can improve over several months, but 25% of those with adult respiratory distress syndrome (ARDS) still have cognitive impairment 6 years later (9).…”

“…These can improve over several months, but 25% of those with adult respiratory distress syndrome (ARDS) still have cognitive impairment 6 years later (9). In those over 65 years old with severe sepsis, impairment can still be present 8 years later (1,3,5). Psychologic consequences include symptoms of depression, anxiety, and sleep disturbances, which can last from months to years (1,3).…”

“…Around 50% of patients who had ARDS have not returned to work 1 year after discharge (9). Less than 10% of patients on mechanical ventilation for over 4 days are alive and independent 1 year later (1)(2)(3)(4)(5).…”

Estilo de vida e intervenções não farmacológicas no tratamento e na prevenção das síndromes geriátricas: uma revisão integrativa

“…De acordo com Brummel, et al (2015), cerca de 50% dos indivíduos com idade igual ou superior a 65 anos desenvolvem um fenômeno natural da senescência, a sarcopenia.…”