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VOLUME 20 , ISSUE 7 ( 2016 ) > List of Articles

RESEARCH ARTICLE

Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital

José Carlos Llamas Reyes, Joaquín Valle Alonso, Javier Fonseca, Margarita Luque Santos, María de los Ángeles Ruiz-Cabello Jiménez, Jay Braniff

Keywords : Elderly, in-hospital mortality, outcome

Citation Information : Reyes JC, Alonso JV, Fonseca J, Santos ML, Jiménez MD, Braniff J. Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital. Indian J Crit Care Med 2016; 20 (7):391-397.

DOI: 10.4103/0972-5229.186219

License: CC BY-ND 3.0

Published Online: 01-01-2014

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Aim: To study all the elderly patients (≥75 years) who were admitted in an Intensive Care Unit (ICU) of a Spanish hospital and identify factors associated with mortality. Patients and Methods: A retrospective, observational data collected prospectively in patients ≥75 years recruited from the ICU in the period of January 2004 to December 2010. Results: During the study period, 1661 patients were admitted to our unit, of whom 553 (33.3%) were older than 75 years. The mean age was 79.9 years, 317 (57.3%) were male, and the overall in-hospital mortality was 94 patients (17% confidence interval 14-20.3%). When comparing patients who survived to those who died, we found significant differences in mean age (P = 0.001), Acute Physiologic Assessment and Chronic Health Evaluation II and Simplified Acute Physiology Scoring II (SAPS II) on admission (P < 0.0001, postoperative patients (P = 0.001), and need for mechanical ventilation (P < 0.0001). Comparing age groups, we found statistically significant differences in SAPS II (P = 0.007), diagnosis of non-ST-segment elevation myocardial infarction (P = 0.014), complicated postoperative period (P = 0.001), and pacemaker (P = 0.034). Mortality between the groups was statistically significant (P = 0.004). The survival between the group of 65 and 74 years and patients >75 years was not significant (P = 0.1390). Conclusions: The percentage of elderly patients in our unit is high, with low mortality rates. The age itself is not the sole determinant for admission to the ICU and other factors should be taken into account.


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  1. López-Messa JB. Age and Intensive Medicine. Med Intensiva 2005;29:469-74.
  2. McDermid RC, Bagshaw SM. ICU and critical care outreach for the elderly. Best Pract Res Clin Anaesthesiol 2011;25:439-49.
  3. Obón B, Gutiérrez I, Sánchez C. Appropriateness of admissions to the intensive care unit in the oldest-old. Rev Esp Geriatr Gerontol 2006;41:193-5.
  4. Lerolle N, Trinquart L, Bornstain C, Tadié JM, Imbert A, Diehl JL, et al. Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med 2010;38:59-64.
  5. Nguyen YL, Angus DC, Boumendil A, Guidet B. The challenge of admitting the very elderly to intensive care. Ann Intensive Care 2011;1:29.
  6. Santana Cabrera L, Sánchez-Palacios M, Hernández Medina E, Eugenio Robaina P, Villanueva-Hernández A. Characteristics and prognosis of patients with very long stay in an intensive care unit. Med Intensiva 2008;32:157-62.
  7. García Lizana F, Manzano Alonso JL, Saavedra Santana P. Mortality and quality of life of patients beyond 65 years one year after ICU discharge. Med Clin (Barc) 2001;116:521-5.
  8. López-Soto A, Sacanella E, Pérez JM. Elderly patient in an intensive critical unit. Rev Esp Geriatr Gerontol 2009;44:27-33.
  9. Galzerano A, Sabatini E, Durì D, Rossi C, Silvestri L, Mazzon D, et al. Old patients in intensive care unit (ICU): What decisions to make? Arch Gerontol Geriatr 2009;49:294-7.
  10. Nathanson BH, Higgins TL, Brennan MJ, Kramer AA, Stark M, Teres D. Do elderly patients fare well in the ICU? Chest 2011;139:825-31.
  11. López-Soto A. Geriatric assessment in the frail elderly hospitalized in the intensive care unit. Rev Multidiscip Gerontol 2005;15:50-3.
  12. Blot S, Cankurtaran M, Petrovic M, Vandijck D, Lizy C, Decruyenaere J, et al. Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: A comparison between middle-aged, old, and very old patients. Crit Care Med 2009;37:1634-41.
  13. Daubin C, Chevalier S, Séguin A, Gaillard C, Valette X, Prévost F, et al. Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: A prospective cohort study. Health Qual Life Outcomes 2011;9:35.
  14. Vosylius S, Sipylaite J, Ivaskevicius J. Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing 2005;34:157-62.
  15. Hwang LC, Hsu CP, Tjung JJ, Shih SC, Lin CH, Huang TH. Predictors of in-hospital mortality in oldest-old patients in Taiwan. Int J Gerontol 2013;7:22-6.
  16. Ely EW, Evans GW, Haponik EF. Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Ann Intern Med 1999;131:96-104.
  17. Obón B, Gutiérrez I, Sánchez C. Patients over 80 years in intensive medicine. Med Intensiva 2009;33:461.
  18. Cheng AC, Cheng KC, Chen CM, Hsing SC, Sung MY. The outcome and predictors of failed extubation in intensive care patients - The elderly is an important predictor. Int J Gerontol 2011;5:206-11.
  19. Grace RF, Gosley M, Smith P. Mortality and outcomes of elderly patients admitted to the intensive care unit at Cairns Base Hospital, Australia. Crit Care Resusc 2007;9:334-7.
  20. Yu W, Ash AS, Levinsky NG, Moskowitz MA. Intensive care unit use and mortality in the elderly. J Gen Intern Med 2000;15:97-102.
  21. Roch A, Wiramus S, Pauly V, Forel JM, Guervilly C, Gainnier M, et al. Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care 2011;15:R36.
  22. Alves GC, Silva Júnior GB, Lima RS, Sobral JB, Mota RM, Abreu KL, et al. Risk factors for death among critically ill elderly patients. Rev Bras Ter Intensiva 2010;22:138-43.
  23. Zhou GP, Song YX, Zhao ZJ. Efficiency of APACHE II and III scoring system in the prognostication of patients older than 75 years. Zhonghua Nei Ke Za Zhi 2005;44:251-3.
  24. Quach S, Hennessy DA, Faris P, Fong A, Quan H, Doig C. A comparison between the APACHE II and Charlson index score for predicting hospital mortality in critically ill patients. BMC Health Serv Res 2009;9:129.
  25. Schönhofer B, Guo JJ, Suchi S, Köhler D, Lefering R. The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation. Eur J Anaesthesiol 2004;21:558-65.
  26. Sakr Y, Krauss C, Amaral AC, Réa-Neto A, Specht M, Reinhart K, et al. Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit. Br J Anaesth 2008;101:798-803.
  27. Mbongo CL, Monedero P, Guillen-Grima F, Yepes MJ, Vives M, Echarri G. Performance of SAPS3, compared with APACHE II and SOFA, to predict hospital mortality in a general ICU in Southern Europe. Eur J Anaesthesiol 2009;26:940-5.
  28. Goel A, Pinckney RG, Littenberg B. APACHE II predicts long-term survival in COPD patients admitted to a general medical ward. J Gen Intern Med 2003;18:824-30.
  29. Hennessy D, Juzwishin K, Yergens D, Noseworthy T, Doig C. Outcomes of elderly survivors of intensive care: A review of the literature. Chest 2005;127:1764-74.
  30. Chelluri L, Pinsky MR, Grenvik AN. Outcome of intensive care of the "oldest-old" critically ill patients. Crit Care Med 1992;20:757-61.
  31. Djaiani G, Ridley S. Outcome of intensive care in the elderly. Anaesthesia 1997;52:1130-6.
  32. Kaarlola A, Tallgren M, Pettilä V. Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med 2006;34:2120-6.
  33. Minne L, Ludikhuize J, de Jonge E, de Rooij S, Abu-Hanna A. Prognostic models for predicting mortality in elderly ICU patients: A systematic review. Intensive Care Med 2011;37:1258-68.
  34. Sprung CL, Artigas A, Kesecioglu J, Pezzi A, Wiis J, Pirracchio R, et al. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly. Crit Care Med 2012;40:132-8.
  35. Fassier T, Duclos A, Abbas-Chorfa F, Couray-Targe S, West TE, Argaud L, et al. Elderly patients hospitalized in the ICU in France: A population-based study using secondary data from the national hospital discharge database. J Eval Clin Pract 2016;22:378-86.
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