Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 27 , ISSUE 3 ( March, 2023 ) > List of Articles

Original Article

A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Center

Pruthvi Prabhudev, Kusugodlu Ramamoorthi, Raviraja V Acharya

Keywords : Acute kidney injury, APACHE II, Blood culture, Elderly, Gram-negative infection, Hemodialysis, Intensive care units, Pneumonia, Procalcitonin, Sepsis

Citation Information : Prabhudev P, Ramamoorthi K, Acharya RV. A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Center. Indian J Crit Care Med 2023; 27 (3):166-175.

DOI: 10.5005/jp-journals-10071-24416

License: CC BY-NC 4.0

Published Online: 28-02-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: The elderly population in India is expected to increase to 319 million by 2050. Managing critically ill elderly patients in intensive care units (ICUs) is a difficult task. Proper planning and development of healthcare infrastructure are of prime importance to face this challenge. Objectives: To study the clinical profile and outcomes of elderly patients admitted to the medical ICUs. Materials and methods: A time-bound, prospective observational study on elderly patients admitted to medical ICUs for more than 48 hours was conducted from March 2019 to September 2020. The demographic, biochemical, hematologic, and microbiological data on antibiotic susceptibility patterns on various organisms and procalcitonin (PCT) reports were collected. Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated. Various treatment modalities, such as mechanical ventilation, inotropes, hemodialysis, antibiotics, culture report in sepsis patients, and length of ICU stay were collected. Results: The age of the patients and the length of their ICU stay were not significantly associated with outcomes. Sepsis and APACHE II scores are significantly associated with outcomes. Receipt of mechanical ventilation, vasopressor support, and hemodialysis are significantly associated with mortality (p < 0.001). Conclusion: The patients’ ages were not significantly associated with outcomes. The most common cause of death among elderly patients was found to be sepsis, followed by pneumonia. In elderly ICU patients, gram-negative organisms are the most common causative agents in bloodstream infections. The APACHE II score, sepsis, receipt of mechanical ventilation, vasopressor support, and hemodialysis are significantly associated with mortality.

HTML PDF Share
  1. Perianayagam A, Bloom D, Lee J, et al. Cohort profile: The Longitudinal Ageing Study in India (LASI). Int J Epidemiol 2022;51(4):e167–e176. DOI: 10.1093/ije/dyab266.
  2. Owojuyigbe AM, Adenekan AT, Babalola RN, et al. Pattern and outcome of elderly admissions into the Intensive Care Unit (ICU) of a low resource tertiary hospital. East Cent Afr J Surg 2016;21(2):40–46. DOI: 10.4314/ecajs.v21i2.6.
  3. Belayachi J, El Khayari M, Dendane T, et al. Factors predicting mortality in elderly patients admitted to a Moroccan medical intensive care unit. South Afr J Crit Care 2012;28(1):22–27. DOI: 10.7196/sajcc.122.
  4. Bagshaw SM, Webb SA, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 2009;13(2):R45. DOI: 10.1186/cc7768.
  5. Reyes JC, Alonso JV, Fonseca J, et al. 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.
  6. Sodhi K, Singla MK, Shrivastava A, et al. 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.
  7. de Rooij SE, Abu-Hanna A, Levi M, et al. Factors that predict outcome of intensive care treatment in very elderly patients: a review. Crit Care 2005;9(4): R307–314. DOI: 10.1186/cc3536.
  8. Lankoandé M, Bonkoungou P, Simporé A, et al. Inhospital outcome of elderly patients in an intensive care unit in a Sub-Saharan hospital. BMC Anesthesiol 2018;18(1):118. DOI: 10.1186/s12871-018-0581-x.
  9. Rodgers JL, Jones J, Bolleddu SI, et al. Cardiovascular risks associated with gender and aging. J Cardiovasc Dev Dis 2019;6(2):19. DOI: 10.3390/jcdd6020019.
  10. Naved SA, Siddiqui S, Khan FH. APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak 2011;21(1):4–8. PMID: 21276376.
  11. Edipoglu IS, Dogruel B, Dizi S, et al. The association between the APACHE-II scores and age groups for predicting mortality in an intensive care unit: a retrospective study. Rom J Anaesth Intensive Care 2019;26(1):53–58. DOI: 10.2478/rjaic-2019-0008.
  12. Upparakadiyala R, Singapati S, Sarkar MK, et al. Clinical profile and factors affecting outcomes in elderly patients admitted to the medical Intensive Care Unit of a Tertiary Care Hospital. Cureus 2022;14(2): e22136. DOI: 10.7759/cureus.22136.
  13. Osman M, Manosuthi W, Kaewkungwal J, et al. Etiology, clinical course, and outcomes of pneumonia in the elderly: a retrospective and prospective cohort study in Thailand. Am J Trop Med Hyg 2021;104(6):2009–2016. DOI: 10.4269/ajtmh.20-1393.
  14. Yahav D, Eliakim-Raz N, Leibovici L, et al. Bloodstream infections in older patients. Virulence 2016;7(3):341–352. DOI: 10.1080/21505594.2015.1132142.
  15. Golli AL, Nitu FM, Balasoiu M, et al. Antibiotic resistance pattern of bacterial pathogens in elderly patients admitted in the intensive care unit. Rev Chem 2018;69(12):3433–3438. DOI:10.37358/RC.18.12.6764.
  16. Li W, Ding C, Yin S. Severe pneumonia in the elderly: a multivariate analysis of risk factors. Int J Clin Exp Med 2015;8(8):12463–12475. PMID: 26550157.
  17. Sousa AL, de Souza LM, Santana Filho OV, et al. Incidence, predictors and prognosis of acute kidney injury in nonagenarians: an in-hospital cohort study. BMC Nephrology 2020;21(1):1–9. DOI: 10.1186/s12882-020-1698-y.
  18. Gancheva GI. Leptospirosis in elderly patients. Braz J Infect Dis 2013;17(5):592–595. DOI: 10.1016/j.bjid.2013.01.012.
  19. Morgan C, Webb RT, Carr MJ, et al. Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death. Lancet Psychiatry 2018;5(11):905–912. DOI: 10.1016/S2215-0366(18)30348-1.
  20. Afzali S, Seifrabiei MA, Taheri SK, et al. Acute poisoning in elderly; a five-year study (2008-2013) in Hamadan, Iran. Asia Pac J Med Toxicol 2015;4(4):143–146. Available from: http://apjmt.mums.ac.ir.
  21. Nasa P, Juneja D, Singh O, et al. Severe sepsis and its impact on outcome in elderly and very elderly patients admitted in intensive care unit. J Intensive Care Med 2012;27(3):179–183. DOI: 10.1177/0885066610397116.
  22. Martin-Loeches I, Guia MC, Vallecoccia MS, et al. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study. Ann Intensive Care 2019;9(1):26. DOI: 10.1186/s13613-019-0495-x.
  23. Malik M, Nair AS, Illango J, et al. The advancement in detecting sepsis and its outcome: usefulness of procalcitonin in diagnosing sepsis and predicting fatal outcomes in patients admitted to intensive care unit. Cureus 2021;13(4): e14439. DOI: 10.7759/cureus.14439.
  24. Paškevičius Ž, Skarupskienė I, Balčiuvienė V, et al. Mortality prediction in patients with severe acute kidney injury requiring renal replacement therapy. Medicina 2021;57(10):1076. DOI: 10.3390/medicina57101076.
  25. Liang J, Li Z, Dong H, et al. Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit: a single-center, retrospective cohort study of 905 patients. Medicine 2019;98(42): e17592. DOI: 10.1097/MD.0000000000017592.
  26. Lim KY, Nik Ab Rahman NH. Predictive factors for special care units admission and in-hospital mortality among geriatric patients that presented to the emergency department of a teaching hospital. Hong Kong J Emerg Med 2019;26(6):336–342. Available from: https://doi.org/10.1177/1024907918802069.
  27. Teles F, Santos RO, Lima HM, et al. The impact of dialysis on critically ill elderly patients with acute kidney injury: an analysis by propensity score matching. J Bras Nephrol 2019;41:14–21. DOI: 10.1590/2175-8239-jbn-2018-0058.
  28. Miniksar ÖH, Özdemir M. Clinical features and outcomes of very elderly patients admitted to the intensive care unit: a retrospective and observational study. Indian J Crit Care Med 2021;25(6):629–634. DOI: 10.5005/jp-journals-10071-23846.
  29. Rhee H, Jang KS, Park JM, et al. Short-and long-term mortality rates of elderly acute kidney injury patients who underwent continuous renal replacement therapy. PLoS One 2016;11(11):e0167067. DOI: 10.1371/journal.pone.0167067.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.