What is the importance of age on treatment of the elderly in the intensive care unit?

Brandberg, Carina; Blomqvist, Hans; Jirwe, Maria

doi:10.1111/aas.12073

Cited by 41 publications

(23 citation statements)

References 24 publications

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“…The finding that age was an independent predictor of treatment restriction is consistent with the literature [22, 30–33], and may indicate that the oldest patients receive less treatment [34, 35]. Older critically ill patients are also more likely to have new treatment restrictions independent of their baseline status, ICU-related illness severity, and worse organ dysfunction status [36].…”

Section: Discussionsupporting

confidence: 76%

Factors associated with life-sustaining treatment restriction in a general intensive care unit

et al. 2017

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PurposeFew previous studies have investigated associations between clinical variables available after 24 hours in the intensive care unit (ICU), including the Charlson Comorbidity Index (CCI), and decisions to restrict life-sustaining treatment. The aim of this study was to identify factors associated with the life-sustaining treatment restriction and to explore if CCI contributes to explaining decisions to restrict life-sustaining treatment in the ICU at a university hospital in Norway from 2007 to 2009.MethodsPatients’ Simplified Acute Physiology Score II (SAPS II), age, sex, type of admission, and length of hospital stay prior to being admitted to the unit were recorded. We retrospectively registered the CCI for all patients based on the medical records prior to the index stay. A multivariable logistic regression analysis was used to assess factors associated with treatment restriction during the ICU stay.ResultsWe included 936 patients, comprising 685 (73%) medical, 204 (22%) unscheduled and 47 (5%) scheduled surgical patients. Treatment restriction was experienced by 241 (26%) patients during their ICU stay. The variables that were significantly associated with treatment restriction in multivariable analysis were older age (odds ratio [OR] = 1.48 per 10 years, 95% confidence interval [CI] = 1.28–1.72 per 10 years), higher SAPS II (OR = 1.05, 95% CI = 1.04–1.07) and CCI values relative to the reference of CCI = 0: CCI = 2 (OR = 2.08, 95% CI = 1.20–3.61) and CCI≥3 (OR = 2.72, 95% CI = 1.65–4.47).ConclusionsIn multivariable analysis, older age, greater illness severity after 24 h in the ICU and greater comorbidity at hospital admission were independently associated with subsequent life-sustaining treatment restriction. The CCI score contributed additional information independent of the SAPS II illness severity rating.

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Section: Discussionsupporting

confidence: 76%

Factors associated with life-sustaining treatment restriction in a general intensive care unit

et al. 2017

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“…However, despite the lack of evidence that these mechanisms of support are less effective in elderly patients, the elderly are often undertreated in clinical practice. Brandberg et al reported that patients ≥80 years admitted to the ICU received significantly less and shorter MV support and had higher in-hospital mortality (33.7% vs. 22.8%) compared to younger patients [35]. Older patients had more limitations in care even after adjustment for severity score and comorbidities.…”

Section: How To Manage Severe Sepsis and Acute Respiratory Failurementioning

confidence: 99%

The management of community-acquired pneumonia in the elderly

Faverio¹,

Aliberti²,

Bellelli³

et al. 2014

European Journal of Internal Medicine

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Pneumonia is one of the main causes of morbidity and mortality in the elderly. The elderly population has exponentially increased in the last decades and the current epidemiological trends indicate that it is expected to further increase. Therefore, recognizing the special needs of older people is of paramount importance. In this review we address the main differences between elderly and adult patients with pneumonia. We focus on several aspects, including the atypical clinical presentation of pneumonia in the elderly, the methods to assess severity of illness, the appropriate setting of care, and the management of comorbidities. We also discuss how to approach the common complications of severe pneumonia, including acute respiratory failure and severe sepsis. Moreover, we debate whether or not elderly patients are at higher risk of infection due to multi-drug resistant pathogens and which risk factors should be considered when choosing the antibiotic therapy. We highlight the differences in the definition of clinical stability and treatment failure between adults and elderly patients. Finally, we review the main outcomes, preventive and supportive measures to be considered in elderly patients with pneumonia.

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“…There is evidence for increased mortality in patients meeting the above organ failure criteria [40][41][42]. Despite evidence that the incidence of WH/WD is independently associated with advancing age, [43,44] age alone even when relatively extreme (N 80 years old) was not considered an appropriate trigger by most round table members. This view by the round table group may be supported by recent data indicating a good self-reported quality of life by elderly ICU survivors [45,46].…”

Section: Discussionmentioning

confidence: 99%

The Durban World Congress Ethics Round Table IV: Health care professional end-of-life decision making

Joynt

Lipman

Hartog³

et al. 2015

Journal of Critical Care

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What is the importance of age on treatment of the elderly in the intensive care unit?

Abstract: Patients above 80 years received less treatment and obtained more limitations in life-sustaining treatments compared with patients aged 65-79, even after adjustment for severity of illness and comorbidity.

Cited by 41 publications

References 24 publications

Factors associated with life-sustaining treatment restriction in a general intensive care unit

Factors associated with life-sustaining treatment restriction in a general intensive care unit

The management of community-acquired pneumonia in the elderly

The Durban World Congress Ethics Round Table IV: Health care professional end-of-life decision making

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