Long-term Outcome of Critically III Elderly Patients Requiring Intensive Care

Objective.—To evaluate the long-term mortality and morbidity of critically ill elderly patients requiring intensive care. Design.—Prospective comparison of outcome of critically ill patients aged 75 years and older with patients aged 65 to 74 years. Patients.—Critically ill patients aged 65 years and older who required intensive care and who were recruited during a 3-month period. Main Outcome Measures.—Duration of hospitalization, hospital charges, procedures used in the intensive care unit, mortality in the hospital and during the follow-up period, and quality of life of survivors during the follow-up period. Results.—Ninety-seven patients were included in the study; 54 were 75 years or older and 43 were aged 65 to 74 years. No significant difference was noted between the two groups for length of stay in the hospital, hospital charges, or mortality at 1 year. Severity of illness, as assessed by Acute Physiology and Chronic Health Evaluation score at the time of intensive care unit admission, was a better predictor of survival than age. Quality of life, as assessed by activities of daily living, perceived quality of life, and Center for Epidemiologic Studies—Depression score, were not significantly different in either group at 1, 6, and 12 months after discharge from the hospital. Most patients in both groups described their quality of life as adequate and were willing to receive intensive care again, if necessary. Conclusion.—Age alone is not an adequate predictor of long-term survival and quality of life in critically ill elderly patients. © 1993, American Medical Association. All rights reserved

Long-term mortality and quality of life after prolonged mechanical ventilation

Objective: To describe and identify factors associated with mortality rate and quality of life 1 yr after prolonged mechanical ventilation. Design: Prospective, observational cohort study with patient recruitment over 26 months and follow-up for 1 yr. Setting: Intensive care units at a tertiary care university hospital. Patients: Adult patients receiving prolonged mechanical ventilation. Interventions: None. Measurements and Main Results: We measured mortality rate and functional status, defined as the inability to perform instrumental activities of daily living (IADLs) 1 yr following prolonged mechanical ventilation. The study enrolled 817 patients. Their median age was 65 yrs, 46% were women, and 44% were alive at 1 yr. Median ages at baseline of 1-yr survivors and nonsurvivors were 53 and 71 yrs, respectively. At the time of admission to the hospital, survivors had fewer comorbidities, lower severity of illness score, and less dependence compared with nonsurvivors. Severity of illness on admission to the intensive care unit and prehospitalization functional status had a significant association with short-term mortality rate, whereas age and comorbidities were related to long-term mortality. Fifty-seven percent of the surviving patients needed caregiver assistance at 1 yr of follow-up. The odds of having IADL dependence at 1-yr among survivors was greater in older patients (odds ratio 1.04 for 1-yr increase in age) and those with IADL dependence before hospitalization (odds ratio 2.27). Conclusions: Mortality rate after prolonged mechanical ventilation is high. Long-term mortality rate is associated with older age and poor prehospitalization functional status. Many survivors needed assistance after discharge from the hospital, and more than half still required caregiver assistance at 1 yr. Interventions providing support for caregivers and patients may improve the functional status and quality of life of both groups and thus need to be evaluated

Hospital costs in patients receiving prolonged mechanical ventilation: Does age have an impact?

Background: The aging of the population is one of the causes of the increase in healthcare costs in the past few decades. It is controversial whether chronological age alone should be used in making healthcare decisions. Objective: To determine the association between age and hospital costs in patients receiving mechanical ventilation (MV). Design: Prospective, observational study. Setting: Intensive care units at a teaching hospital. Patients: A total of 813 adults who received prolonged (≥48 hrs) mechanical ventilation. Intervention: None. Measurements: Severity of illness, comorbidities, length of stay, hospital costs, and mortality. We evaluated the independent association of age with hospital costs using linear regression. Results: Mean (±SD) age of patients was 60.4 ± 18.8 yrs. Median Acute Physiology Chronic Health Evaluation III score and probability of hospital death at intensive care unit admission were 64 and 0.31, respectively. Hospital mortality was 36%. Median total hospital costs and daily costs were $56,056 and$2,655, respectively. Older age was associated with lower total hospital costs after controlling for sex, intensive care unit type, severity of illness, length of stay, insurance type, resuscitation status, and survival. Hospital costs were significantly less in older patients in all cost departments examined, except for respiratory care and intensive care unit room costs. Conclusions: Daily and total hospital costs were lower in older patients. Decreased hospital resource use in older patients may be related to a preference for less aggressive care by older patients and their families or by healthcare providers