The 1-year trajectory of older patients transferred from an intensive care unit to an acute geriatric unit

The benefits of intensive care (in terms of the maintenance of functional independence and a reduction in the mortality rate in older patients) are still subject to debate, and the value of geriatric care of older adults discharged from an intensive care unit (ICU) has not been extensively studied. The objective of the present study was to examine the 1-year trajectory of patients transferred from an ICU to an acute geriatric unit (AGU).

We conducted an ambispective, descriptive, single-center study of older adults aged 75 and over from the DAMAGE cohort and having been transferred from an ICU to an AGU. The outcomes (functional independence, according to the Katz Activities of Daily Living (ADL) scale, place of living, and mortality) were documented on discharge from the AGU and 3 and 12 months thereafter.

Of the 3,500 older adults in the DAMAGE cohort, 130 patients had been admitted to an ICU and transferred to an AGU. Before hospitalization, the median ADL score was 5 out of 6 (interquartile range [IQR] 4-6), with a majority of people living at home (n = 106, 82%). On discharge from the AGU, 113 patients were alive and had a median ADL score of 4 (IQR [2-5]). Fifty-nine patients (52.2%) were discharged to home. At 3 months and 12 months post-discharge, respectively, 97 (85.8%) and 79 (69.9%) patients were still alive and were functionally independent (median ADL scores: 4.5 (IQR [4; 5.5] and 5 (IQR [4-6])); 75 (66.4%) and 57 (50.4%) were still living at home.

Our results show that many older adults transferred from ICU to an AGU maintain their functional independence, which enables them to be discharged to home and remain there for at least the following year. Further research should address the detection of geriatric syndromes at an early stage and the identification of patients who could benefit from the ICU-AGU trajectory.