Intensive care unit outcome in the very elderly

Area of Science:

• Geriatric Medicine
• Critical Care Medicine
• Epidemiology

Background:

• The very elderly (>= 85 years) admitted to the Intensive Care Unit (ICU) represent a growing population with unique health challenges.
• Understanding factors influencing their outcomes is crucial for effective medical management and resource allocation.

Purpose of the Study:

• To investigate the impact of age, previous functional status, and acute illness severity on mortality and functional outcomes in very elderly patients following ICU admission.
• To identify key predictors of survival and functional recovery in this vulnerable demographic.

Main Methods:

• A cohort study design was employed, with retrospective and prospective data collection over a two-year period.
• Data included 105 patients aged 85 years or older admitted to an ICU in a community teaching hospital.
• Primary outcome measures included ICU, 30-day, and 1-year mortality rates, along with activities of daily living (ADL) scores and organ system failure scores at ICU admission.

Main Results:

• Overall mortality rates were 30% (ICU), 43% (30-day post-hospital discharge), and 64% (1-year).
• A higher number of organ system failures at ICU admission was significantly associated with increased ICU and 1-year mortality (OR 3.38 and 5.76, respectively).
• Neither advanced age nor pre-admission functional status independently predicted mortality in this cohort.

Conclusions:

• Acute severity of illness, quantified by organ system failures, is the primary determinant of mortality in very elderly ICU patients.
• For the majority of very elderly survivors of ICU admission, functional status remains largely unchanged one year after discharge.