The very elderly in intensive care: admission characteristics and mortality

It is often assumed that critical care outcomes in the elderly are uniformly poorer than those in younger populations. We examined the pattern of admissions to our intensive care unit in Dublin, Ireland, between 2002 and 2005 to determine the admission characteristics and mortality in those aged 80 years and older.

Data were collected retrospectively from a local audit database and patient charts.

The very elderly represented 5.1% of ICU admissions over the period with an ICU mortality of 15.4%. Age-adjusted APACHE II scores were similar to those in the younger group (median, 7 for both groups). The average length of ICU stay (+/-SD) was similar in the very elderly and younger groups (4.03+/-0.51 v 4.86+/-0.31 days; P=0.52), as were readmission rates (5.7% v 5.2%). Age was not predictive of ICU mortality. The most important determinants of ICU mortality were emergency (versus elective) admission, non-operative (versus postoperative) source of admission and higher age-adjusted APACHE II score.

The nature of the admission and severity of illness, but not age, are determinants of ICU survival. Evidence-based criteria are needed to assess the appropriateness of ICU admission in the very elderly. Clear criteria would help to prevent initiation of futile therapies and also to ensure that the very elderly are not denied potentially beneficial ICU care. We need to study triage patterns and outcome data further to ensure that the very elderly have the same opportunities to access appropriate intensive care treatment as the rest of the population.