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, 30 (9), 1041-1051

Outcome of Older Persons Admitted to Intensive Care Unit, Mortality, Prognosis Factors, Dependency Scores and Ability Trajectory Within 1 Year: A Prospective Cohort Study

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Outcome of Older Persons Admitted to Intensive Care Unit, Mortality, Prognosis Factors, Dependency Scores and Ability Trajectory Within 1 Year: A Prospective Cohort Study

Claude Level et al. Aging Clin Exp Res.

Abstract

Background: The outcome and functional trajectory of older persons admitted to intensive care (ICU) unit remain a true question for critical care physicians and geriatricians, due to the heterogeneity of geriatric population, heterogeneity of practices and absence of guidelines.

Aim: To describe the 1-year outcome, prognosis factors and functional trajectory for older people admitted to ICU.

Methods: In a prospective 1-year cohort study, all patients aged 75 years and over admitted to our ICU were included according to a global comprehensive geriatric assessment. Follow-up was conducted for 1 year survivors, in particular, ability scores and living conditions.

Results: Of 188 patients included [aged 82.3 ± 4.7 years, 46% of admissions, median SAPS II 53.5 (43-74), ADL of Katz's score 4.2 ± 1.6, median Barthel's index 71 (55-90), AGGIR scale 4.5 ± 1.5], the ICU, hospital and 1-year mortality were, respectively, 34, 42.5 and 65.5%. Prognosis factors were: SAPS 2, mechanical ventilation, comorbidity (Lee's and Mc Cabe's scores), disability scores (ADL of Katz's score, Barthel's index and AGGIR scale), admission creatinin, hypoalbuminemia, malignant haemopathy, cognitive impairment. One-year survivors lived in their own home for 83%, with a preserved physical ability, without significant variation of the three ability assessed scores compared to prior ICU admission.

Conclusion: The mortality of older people admitted to ICU is high, with a significant impact of disabilty scores, and preserved 1-year survivor independency. Other studies, including a better comprehensive geriatric assessment, seem necessary to determine a predictive "phenotype" of survival with a "satisfactory" level of autonomy.

Keywords: Ability and ADL scores; Comprehensive geriatric assessment; Ethics; Intensive care unit; Older persons; Survival.

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