Differences in intensive care outcomes between older adults with and without dementia: A systematic review and...

Intensive care unit (ICU) admissions among older adults with dementia have more than doubled in the past two decades, now representing over 15% of ICU admissions. This population is particularly vulnerable to functional decline and complications following critical illness. This study systematically reviewed evidence on ICU utilization and outcomes among older adults with dementia compared with those without dementia.

We conducted a systematic review and random-effects meta-analysis of cohort studies (2003-2023) identified in MEDLINE, EMBASE, SCOPUS, and Web of Science. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

Fifteen studies from six countries including 1,738,285 patients (173,107 with dementia) met inclusion criteria. Adjusted analyses showed no difference in ICU mortality (OR 1.05,95%CI 1.00-1.11;n = 1). However, dementia was associated with higher 30-day (OR 1.54,95%CI 1.47-1.62;n = 1) and 12-month mortality (OR 1.95,95%CI 1.88-2.02;n = 1). Patients with dementia also had lower odds of receiving mechanical ventilation (OR 0.69,95%CI 0.60-0.80;n = 3) and higher odds of developing delirium (OR 4.80, 95%CI 1.81-12.72;n = 1).

Older adults with dementia admitted to ICUs experience similar ICU mortality but higher long-term mortality, more delirium, and lower odds of mechanical ventilation. These findings highlight the need for prospective studies to guide patient-centered ICU care in this population.