Abstract
Purpose
To evaluate the development of demographics and outcome of very old (>80 years) critically ill patients admitted to intensive care units.
Setting
All consecutive patients admitted to 41 Austrian intensive care units (ICUs) over an 11-year period.
Methods
We performed a retrospective cohort study of prospectively collected data. To compare parameters over time, patients were divided into three groups (group I from 1998 until 2001, group II from 2002 to 2004, and group III from 2005 to 2008).
Results
A total of 17,126 patients older than 80 years of age were admitted over the study period. The proportion of very old patients increased from 11.5% (I) to 15.3% (III) with a significant higher prevalence of females in all groups (on average 63.2%). Severity of illness also increased over time, even when corrected for age. Use of noninvasive mechanical ventilation increased over the years. However, risk-adjusted mortality rates [observed-to-expected (O/E) ratios] decreased from 1.14 [confidence interval (CI) 1.11–1.18] to 1.02 (CI 0.99–1.05). This improvement in outcome was confirmed on multivariate analysis: for every year delay in ICU admission, the odds to die decreased by 3%. Moreover, females exhibited a better outcome compared with males.
Conclusions
The relative and absolute numbers of very old patients increased over the study period, as did the severity of illness. Despite this, risk-adjusted hospital mortality improved over the study period. Females dominated in the very old patients and exhibited moreover a better outcome compared with males.
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References
Department of Economic and Social Affairs: World population ageing 2009. United Nations, New York. www.un.org/esa/population/publications/WPA2009. Accessed 26 April 2011
Bongaarts J (2009) Human population growth and the demographic transition. Phil Trans R Soc B 364:2985–2990
Lutz W, Sanderson W, Scherbov S (2008) The coming acceleration of global population ageing. Nature 451:716–719
Rosenthal GE, Kaboli PJ, Barnett MJ, Sirio CA (2002) Age and the risk of in-hospital death: insights from a multihospital study of intensive care patients. J Am Geriatr Soc 50:1205–1212
Creditor MC (1993) Hazards of hospitalization of the elderly. Ann Intern Med 118:219–222
Bagshaw SM, Webb SAR, Delaney A, George C, Pilcher D, Hart GK, Bellomo R (2009) Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 13:R45
Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29:2137–2143
Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B (2007) Should elderly patients be admitted to the intensive care unit? Intensive Care Med 33:1252–1262
Nguyen YL, Angus DC, Boumendil A, Guidet B (2011) The challenge of admitting the very elderly to intensive care. Ann Intensive Care 1:29
Metnitz PhGH, Vesely H, Valentin A, Popow C, Hiesmayr M, Lenz K, Krenn CG, Steltzer H (1999) Evaluation of an interdisciplinary data set for national ICU assessment. Crit Care Med 27:1486–1491
Metnitz PhGH, Steltzer H, Popow C, Valentin A, Lenz K, Neumark J, Sagmüller G, Schwameis F, Urschitz M, Hiesmayr M (1997) Definition and evaluation of a documentation standard for intensive care medicine: the ASDI pilot project. Wien Klin Wochenschr 109:132–138
Le Gall JR, Lemeshow St, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
Miranda DR, De Rijk A, Schaufeli W (1996) Simplified therapeutic interventions scoring system: the TISS-28 items—results from a multicenter study. Crit Care Med 4:64–73
Metnitz PhGH, Krenn CG, Steltzer H, Lang Th, Ploder J, Lenz K, Le Gall JR, Druml W (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058
Hosmer DW, Lemeshow S (1995) Confidence interval estimates of an index of quality performance based on logistic regression models. Stat Med 14:2161–2172
Bauer P, Poetscher BM, Hackl P (1988) Model selection by multiple test procedures. Statistics 19:39–44
Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J (2000) Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease. JAMA 284:2762–2770
Statistik Austria, Bundesanstalt Statistik Österreich, A 1110 Vienna. http://www.statistik.at. Accessed 26 April 2011
Garrouste-Orgeas M, Timsit JF, Montuclard L, Colvez A, Gattoliat O, Philippart F, Rigal G, Misset B, Carlet J (2006) Decision-making progress, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med 32:1045–1051
Hamel MB, Teno JM, Goldmann L, Lynn J, Davis RB, Galanos AN, Desbiens N, Connors AF, Wenger N, Phillips RS (1999) Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. Ann Intern Med 130:116–125
Garrouste-Orgeas M, Boumendil A, Pateron D, Aergerter P, Somme D, Simon T, Guidet B, ICE-CUB Group (2009) Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational, multicenter, prospective study. Crit Care Med 37:2919–2928
Boumendil A, Aegerter P, Guidet B, the CUB-Rea Network (2005) Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc 53:88–93
Lerolle N, Trinquart L, Bornstain C, Tadié JM, Imbert A, Diehl JL, Fagon JY, Guérot E (2010) Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med 38:59–64
Needham DM, Bronskill SE, Calinawan JR, Sibbald WJ, Pronovost PJ, Laupacis A (2005) Projected incidence of mechanical ventilation in Ontario to 2026: preparing for the aging baby boomers. Crit Care Med 33:574–579
Van Den Noorgate N, Vogelaers D, Afschrift M, Colardyn F (1999) Intensive care for elderly patients: outcome and risk factors for in-hospital mortality. Age Ageing 28:253–256
Nin N, Lorente JA, Paula M, Fernandez Segoviano P, Penuelas O, Sanchez Ferrer A, Martinez Caro L, Esteban A (2008) Ageing increases the susceptibility to injurious mechanical ventilation. Intensive Care Med 34:923–931
Behrendt CE (2000) Acute respiratory failure in the United States: Incidence and 31-day survival. Chest 118:1100–1105
Ely EW, Wheeler AP, Thompson BT, Ancukiewicz M, Steinberg KP, Bernard GR (2002) Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome. Ann Intern Med 136:25–36
Evans TW (2001) International consensus conferences in intensive care medicine: non-invasive positive pressure ventilation in acute respiratory failure. Intensive Care Med 27:166–178
Demoule A, Girou E, Richard JC, Taillé S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755
Nava S, Grassi M, Fanfulla F, Domenighetti G, Carlucci A, Perren A, Dell’orso D, Vitacca M, Ceriana P, Karakurt Z, Clini E (2011) Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomized controlled trial. Age Ageing 40:444–450
Nicolas F, Le Gall JR, Alperovitch A, Loirat P, Villers D (1987) Influence of patients’ age on survival, level of therapy and length of stay in intensive care units. Intensive Care Med 13:9–13
Goldhill DR, Sumner A (1998) Outcome of intensive care patients in a group of British intensive care units. Crit Care Med 26:1337–1345
Oeppen J, Vaupel JW (2002) Broken limits to life expectancy. Science 296:1029–1031
Pietropaoli AP, Glance LG, Oakes D, Fisher SG (2010) Gender differences in mortality in patients with sever sepsis or septic shock. Gend Med 7:422–437
Fowler RA, Sabur N, Li P, Juurlink DN, Pinto R, Hladunewich MA, Adhikari NKJ, Sibbald WJ, Martin CM (2007) Sex- and age-based differences in the delivery and outcomes of critical care. CMAJ 177:1513–1519
Reinikainen M, Niskanen M, Uusaro A, Ruokonen E (2005) Impact of gender on treatment and outcome of ICU patients. Acta Anaesthesiol Scand 49:984–990
Valentin A, Jordan B, Lang T, Hiesmayr M, Metnitz PGH (2003) Gender-related differences in intensive care: a multiple center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med 31:1901–1907
Acknowledgments
We thank the members of the ASDI study group and their study coordinators in each ICU for their valuable contribution.
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Philipp G. H. Metnitz: senior author.
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Ihra, G.C., Lehberger, J., Hochrieser, H. et al. Development of demographics and outcome of very old critically ill patients admitted to intensive care units. Intensive Care Med 38, 620–626 (2012). https://doi.org/10.1007/s00134-012-2474-7
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DOI: https://doi.org/10.1007/s00134-012-2474-7