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VOLUME 18 , ISSUE 12 ( December, 2014 ) > List of Articles


Do Intensive Care Unit treatment modalities predict mortality in geriatric patients: An observational study from an Indian Intensive Care Unit

Manender Kumar Singla,, Anupam Shrivastava,, Namita Bansal

Keywords : Geriatrics, hemodialysis, Intensive Care Unit outcomes, inotropes, mechanical ventilation, tracheostomy

Citation Information : Singla, MK, Shrivastava, A, Bansal N. Do Intensive Care Unit treatment modalities predict mortality in geriatric patients: An observational study from an Indian Intensive Care Unit. Indian J Crit Care Med 2014; 18 (12):789-795.

DOI: 10.4103/0972-5229.146312

License: CC BY-ND 3.0

Published Online: 01-03-2009

Copyright Statement:  Copyright © 2014; The Author(s).


Background: Ageing being a global phenomenon, increasing number of elderly patients are admitted to Intensive Care Units (ICU). Hence, there is a need for continued research on outcomes of ICU treatment in the elderly. Objectives: Examine age-related difference in outcomes of geriatric ICU patients. Analyze ICU treatment modalities predicting mortality in patients >65 years of age. Materials and Methods: A retrospective observational study was conducted in 2317 patients admitted in a multi-specialty ICU of a tertiary care hospital over 2-year study period from January 1, 2011 to December 31, 2012. A clinical database was collected which included age, sex, specialty under which admitted, APACHE-II and SOFA scores, patient outcome, average length of ICU stay, and the treatment modalities used in ICU including mechanical ventilation, inotropes, hemodialysis, and tracheostomy. Patients were divided into two groups: <65 years (Control group) and >65 years (Geriatric age group). Results: The observed overall ICU mortality rate in the study population was 19.6%; no statistical difference was observed between the control and geriatric age group in overall mortality (P > 0.05). Mechanical ventilation (P = 0.003, odds ratio [OR] =0.573, 95% confidence interval [CI] =0.390-0.843) and use of inotropes (P = 0.018, OR = 0.661, 95% CI = 0.456-0.958) were found to be predictors of mortality in elderly population. On multivariate analysis, inotropic support was found to be an independent ICU treatment modality predicting mortality in the geriatric age group (β coefficient = 1.221, P = 0.000). Conclusion: Intensive Care Unit mortality rates increased in the geriatric population requiring mechanical ventilation and inotropes during ICU stay. Only inotropic support could be identified as independent risk factor for mortality.

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  1. Prognostic factors in elderly patients admitted in the intensive care unit. Rev Bras Ter Intensiva 2009;21:255-61.
  2. Factors predicting mortality in elderly patients admitted to a Moroccan medical intensive care unit. South Afr J Crit Care 2012;28:22-7.
  3. Outcomes of elderly survivors of intensive care: A review of the literature. Chest 2005;127:1764-74.
  4. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: Can we meet the requirements of an aging population? JAMA 2000;284:2762-70.
  5. Management of the critically ill geriatric patient. Crit Care Med 2006;34:S176-82.
  6. Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing 2005;34:157-62.
  7. Age and the risk of in-hospital death: Insights from a multihospital study of intensive care patients. J Am Geriatr Soc 2002;50:1205-12.
  8. Risk factors for mortality among elderly people. Rev Saude Publica 2006;40:1049-56.
  9. Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 1993;269:3119-23.
  10. Critically ill elderly who require mechanical ventilation: The effects of age on survival outcomes and resource utilisation in the medical intensive care unit of a general hospital. Ann Acad Med Singapore 2003;32:691-6.
  11. Intensive care for very elderly patients: Outcome and risk factors for in-hospital mortality. Age Ageing 1999;28:253-6.
  12. One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med 1993;21:687-91.
  13. Factors that predict outcome of intensive care treatment in very elderly patients: A review. Crit Care 2005;9:R307-14.
  14. Should elderly patients be admitted to the intensive care unit? Intensive Care Med 2007;33:1252-62.
  15. Mortality in healthy elderly patients after ICU admission. Intensive Care Med 2009;35:550-5.
  16. Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med 2006;32:1039-44.
  17. Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc 2008;56:816-22.
  18. Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med 2006;34:2120-6.
  19. Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Ann Intern Med 1999;131:96-104.
  20. The outcome of mechanical ventilation: Report of a five year study. Ann R Coll Surg Engl 1985;67:187-9.
  21. Respiratory failure in the elderly. Analysis of outcome after treatment with mechanical ventilation. Arch Intern Med 1993;153:1657-62.
  22. Mechanical ventilation in elderly patients. Monaldi Arch Chest Dis 1998;53:547-51.
  23. The outcome of prolonged mechanical ventilation in elderly patients: Are the efforts worthwhile? Age Ageing 1996;25:353-6.
  24. Mechanical ventilation for the elderly patient in intensive care. Incremental changes and benefits. JAMA 1993;269:1025-9.
  25. Hospital and posthospital survival in patients mechanically ventilated for more than 29 days. Chest 1992;101:211-4.
  26. The impact of age on disposition for mechanically ventilated patients: An examination of 41 926 patients. Chest 1992;102:S149.
  27. Outcome and costs of intensive care. A follow-up study on patients requiring prolonged mechanical ventilation. Acta Anaesthesiol Scand 1987;31:693-8.
  28. Outcome of critically ill oldest-old patients (aged 90 and older) admitted to the intensive care unit. J Am Geriatr Soc 2006;54:110-4.
  29. Outcomes of critically ill elderly patients: Is high-dependency care for geriatric patients worthwhile? Crit Care Med 1999;27:2351-7.
  30. Predictors of long-term mortality after severe sepsis in the elderly. Am J Med Sci 2014;347:282-8.
  31. Long-term outcomes and clinical predictors of hospital mortality in very long stay intensive care unit patients: A cohort study. Crit Care 2006;10:R59.
  32. Management and 1 year outcome of oldest-old hospitalized heart failure patients: A subacute geriatric hospital survey. Isr Med Assoc J 2010;12:483-8.
  33. Clinical practices and outcomes in elderly hemodialysis patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol 2011;6:1651-62.
  34. Causes and prognosis of acute renal failure in elderly patients. Rev Assoc Med Bras 2000;46:212-7.
  35. Mortality and outcomes of elderly patients admitted to the intensive care unit at Cairns Base Hospital, Australia. Crit Care Resusc 2007;9:334-7.
  36. An audit of characteristics and outcomes in adult intensive care patients following tracheostomy. Indian J Crit Care Med 2012;16:100-5.
  37. Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med 2005;33:290-8.
  38. Clinical outcomes for the elderly patient receiving a tracheotomy. Head Neck 2004;26:71-5.
  39. Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Ann Intern Med 1999;130:116-25.
  40. Do-not-resuscitate orders in intensive care units. Current practices and recent changes. JAMA 1993;270:2213-7.
  41. Variation in the use of do-not-resuscitate orders in patients with stroke. Arch Intern Med 1997;157:1841-7.
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