Propensity-Adjusted Comparison of Mortality of Elderly Versus Very Elderly Ventilated Patients

Respir Care. 2021 May;66(5):814-821. doi: 10.4187/respcare.08547. Epub 2021 Mar 2.


Background: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation.

Methods: In total, 5,557 mechanically ventilated subjects were included in our post hoc retrospective analysis, a subgroup of the VENTILA study. We divided the cohort into 2 subgroups on the basis of age: very elderly subjects (age ≥ 80 y; n = 1,430), and elderly subjects (age 65-79 y; n = 4,127). A propensity score on being very elderly was calculated. Evaluation of associations with 28-d mortality was done with logistic regression analysis.

Results: Very elderly subjects were clinically sicker as expressed by higher SAPS II scores (53 ± 18 vs 50 ± 18, P < .001), and their rates of plateau pressure < 30 cm H2O were higher, whereas other parameters did not differ. The 28-d mortality was higher in very elderly subjects (42% vs 34%, P < .001) and remained unchanged after propensity score adjustment (adjusted odds ratio 1.31 [95% CI 1.16-1.49], P < .001).

Conclusions: Age was an independent and unchangeable risk factor for death in mechanically ventilated subjects. However, survival rates of very elderly subjects were > 50%. Denial of critical care based solely on age is not justified. ( registration NCT02731898.).

Keywords: ICU; critically ill; elderly subjects; mechanical ventilation; risk scores; risk stratification.

MeSH terms

  • Aged
  • Critical Illness*
  • Humans
  • Intensive Care Units
  • Respiration, Artificial*
  • Retrospective Studies
  • Risk Factors
  • Simplified Acute Physiology Score

Associated data