Characteristics and Outcomes of Very Elderly Patients Admitted to Intensive Care: A Retrospective Multicenter Cohort Analysis.
Sumeet Rai 1 2, Charlotte Brace 3, Paul Ross 4 5, Jai Darvall 6 7, Kimberley Haines 6 8, Imogen Mitchell 1 2, Frank van Haren 1 9, David Pilcher 4 5 10
Crit Care Med. 2023 May 23. doi: 10.1097/CCM.0000000000005943. Online ahead of print.PMID: 37219961
Abstract
Objectives: To characterize and compare trends in ICU admission, hospital outcomes, and resource utilization for critically ill very elderly patients (≥ 80 yr old) compared with the younger cohort (16-79 yr old).
Design: A retrospective multicenter cohort study.
Setting: One-hundred ninety-four ICUs contributing data to the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database between January 2006 and December 2018.
Patients: Adult (≥ 16 yr) patients admitted to Australian and New Zealand ICUs.
Interventions: None.
Measurements and main results: Very elderly patients with a mean ± sd age of 84.8 ± 3.7 years accounted for 14.8% (232,582/1,568,959) of all adult ICU admissions. They had higher comorbid disease burden and illness severity scores compared with the younger cohort. Hospital (15.4% vs 7.8%, p < 0.001) and ICU mortality (8.5% vs 5.2%, p < 0.001) were higher in the very elderly. They stayed fewer days in ICU, but longer in hospital and had more ICU readmissions. Among survivors, a lower proportion of very elderly was discharged home (65.2% vs 82.4%, p < 0.001), and a higher proportion was discharged to chronic care/nursing home facilities (20.1% vs 7.8%, p < 0.001). Although there was no change in the proportion of very elderly ICU admissions over the study period, they showed a greater decline in risk-adjusted mortality (6.3% [95% CI, 5.9%-6.7%] vs 4.0% [95% CI, 3.7%-4.2%] relative reduction per year, p < 0.001) compared with the younger cohort. The mortality of very elderly unplanned ICU admissions improved faster than the younger cohort (p < 0.001), whereas improvements in mortality among elective surgical ICU admissions were similar in both groups (p = 0.45).
Conclusions: The proportion of ICU admissions greater than or equal to 80 years old did not change over the 13-year study period. Although their mortality was higher, they showed improved survivorship over time, especially in the unplanned ICU admission subgroup. A higher proportion of survivors were discharged to chronic care facilities.
Copyright © 2023 The Author(s).
Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
Conflict Of Interest Statement
Dr. Haines’ institution received funding from the Society of Critical Care Medicine. Dr. van Haren’s institution received funding from the Australian National University; he received funding from Phico Therapeutics and Fresenius Kabi. The remaining authors have disclosed that they do not have any potential conflicts of interest.