Mortality in elderly ICU patients: a cohort study
M S Nielsson1, C F Christiansen, M B Johansen
1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark.
Acta Anaesthesiologica Scandinavica
|October 15, 2013
Summary
The proportion of elderly intensive care unit (ICU) patients rose by 18% between 2005 and 2011. Advanced age significantly increases mortality risk, even when considering pre-existing health conditions.
Area of Science:
- Geriatric Medicine
- Critical Care Medicine
- Public Health
Background:
- The global population is aging, leading to an increased number of elderly individuals requiring intensive care.
- Understanding the trends and outcomes of elderly patients in intensive care units (ICUs) is crucial for healthcare planning.
Purpose of the Study:
- To analyze changes in the proportion of elderly (≥80 years) intensive care unit (ICU) patients from 2005 to 2011.
- To investigate the association between advanced age and mortality, while controlling for pre-existing morbidity.
Main Methods:
- A cohort of 49,938 ICU admissions in Northern Denmark (2005-2011) was analyzed using the Danish National Patient Registry.
- Patients were categorized into age groups (15-49, 50-64, 65-79, and ≥80 years).
- Thirty-day and 31-365-day mortality rates and mortality rate ratios (MRRs) were estimated, stratified by admission type (medical, acute surgical, elective surgical) and adjusted for sex and pre-existing morbidity.
Main Results:
- The proportion of elderly ICU patients increased from 11.7% in 2005 to 13.8% in 2011 (an 18% rise).
- Among elderly patients, 30-day mortality rates were 43.7% (medical), 39.6% (acute surgical), and 11.6% (elective surgical).
- Adjusted 30-day MRRs for elderly patients compared to 50-64-year-olds ranged from 2.7 (medical/acute surgical) to 5.2 (elective surgical).
Conclusions:
- There was a significant increase in the proportion of elderly patients admitted to the ICU between 2005 and 2011.
- Advanced age is independently associated with a higher risk of mortality in ICU patients, irrespective of pre-existing health conditions.
Related Concept Videos
01:21Acute Respiratory Failure-II
1.8K
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
1.8K
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
764
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
764
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
406
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
406
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
378
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
378
01:00Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
387
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
387
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
358
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
358