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Do elderly patients fare well in the ICU?
Brian H Nathanson1, Thomas L Higgins2, Maura J Brennan2
1From OptiStatim, LLC, Longmeadow, MA.
Background:
A recent update of the Mortality Probability Model (MPM)-III found 14% of intensive care patients had age as their only MPM risk factor for hospital mortality. This subgroup had a low mortality rate (2% vs 14% overall), and pronounced differences were noted among elderly patients. This article is an expanded analysis of age-related mortality rates in patients in the ICU.
Methods:
Project IMPACT data from 135 ICUs for 124,885 patients treated from 2001 to 2004 were analyzed. Patients were stratified as elective surgical, emergency/unscheduled surgical, and medical and then further stratified by age and whether additional MPM risk factors were present or absent.
Results:
Mortality rose with advancing age within all patient categories. Elective surgical patients without other risk factors were the least likely to die at all ages (0.4% for patients aged 18-29 years to 9.2% for patients aged ≥ 90 years), whereas medical patients with one or more additional risk factors had the highest mortality rate (12.1% for patients aged 18-29 years to 36.0% for patients aged ≥ 90 years). In these two subsets, mortality rates approximately doubled in the elective surgical group among patients aged in their 70s (2.4%), 80s (4.3%), and 90s (9.2%) but rose less dramatically in the medical group (27.0%, 30.7%, and 36.0%, respectively).
Conclusions:
Although mortality increased with age, the risk differed significantly by patient subset, even among elderly patients, which may reflect a selection bias. Advanced age alone does not preclude successful surgical and ICU interventions, although the presence of serious comorbidities decreases the likelihood of survival to discharge for all age groups.
Insights
Advanced age alone is not a significant predictor of mortality in intensive care units (ICUs). Patient subgroup and comorbidities significantly influence survival rates, even in elderly patients.
Area of Science:
- Critical Care Medicine
- Geriatric Medicine
- Health Services Research
Background:
- A prior analysis of the Mortality Probability Model (MPM)-III indicated that 14% of intensive care unit (ICU) patients had age as their sole risk factor for hospital mortality.
- This specific subgroup exhibited a notably lower mortality rate (2%) compared to the overall ICU mortality rate (14%).
- Significant variations in mortality rates were observed among elderly patients based on their clinical profiles.
Purpose of the Study:
- To conduct an in-depth analysis of age-related mortality patterns in intensive care unit (ICU) patients.
- To investigate how patient stratification (surgical vs. medical) and the presence of additional risk factors modify the impact of age on mortality.
- To provide a nuanced understanding of mortality risk beyond chronological age in critical care settings.
Main Methods:
- Utilized data from Project IMPACT, encompassing 124,885 patients across 135 ICUs between 2001 and 2004.
- Stratified patients into elective surgical, emergency/unscheduled surgical, and medical categories.
- Further categorized patients by age groups and the presence or absence of additional MPM risk factors to assess mortality differentials.
Main Results:
- Mortality rates consistently increased with advancing age across all patient categories.
- Elective surgical patients without other risk factors demonstrated the lowest mortality (0.4% in 18-29 year olds to 9.2% in ≥90 year olds).
- Medical patients with additional risk factors exhibited the highest mortality (12.1% in 18-29 year olds to 36.0% in ≥90 year olds).
- Mortality in elective surgical patients aged 70s, 80s, and 90s approximately doubled (2.4% to 9.2%), while rising less dramatically in the medical group (27.0% to 36.0%).
Conclusions:
- While mortality increases with age, the specific patient subgroup significantly impacts risk, even among the elderly, suggesting potential selection bias.
- Advanced age itself should not be a barrier to ICU and surgical interventions.
- The presence of comorbidities substantially diminishes the likelihood of survival to discharge across all age groups.
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