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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2016 Nov 30
Critically ill octogenarians and nonagenarians: evaluation of long-term outcomes, post-hospital trajectories and quality of life one year and seven years after ICU discharge
Sandra OEYEN 1, 2, Joris VERMASSEN 1, 2, Ruth PIERS 2, 3, Dominique BENOIT 1, 2, Lieven ANNEMANS 4, Johan DECRUYENAERE 1, 2 ✉
1 Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium; 2 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; 3 Department of Geriatrics, Ghent University Hospital, Ghent, Belgium; 4 I-CHER Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
BACKGROUND: To investigate long-term outcomes, post-hospital trajectories, and quality of life (QOL) in patients ≥ 80 years admitted to the intensive care unit (ICU) of a tertiary care hospital.
METHODS: A 1-year prospective observational cohort analysis was performed. All consecutive patients ≥ 80 years admitted to the ICU were screened for inclusion. Demographics, comorbidity, organ failures, and outcomes were analyzed. QOL before admission, 3 months, 1 year, and 7 years after ICU discharge was assessed using EuroQoL-5D (EQ-5D) and Medical Outcomes Study 36-item Short Form Health Survey (SF-36) questionnaires. Statistical significance was attained at P<0.05.
RESULTS: 131 patients with a median age of 83 years (IQR 81-85), a Charlson comorbidity index of 2 (IQR 0-4), a SOFA score of 4 (3-8) upon ICU admission and an APACHE II score of 20 (IQR 15-24) were included. ICU, hospital, 3 months, 1-year, and 7-years mortality rates were 17%, 29%, 39%, 50%, and 84% respectively. QOL decreased significantly over time. Most elderly considered QOL as acceptable and perceived only a worsening in physical functioning and self-care at long-term. Of the 1- year and 7-years survivors, 21% and 39% (P=0.122) lived in nursing homes, and 81% and 72% (P=0.423) preferred to be readmitted to an ICU department if necessarily.
CONCLUSIONS: Most critically ill long-term elderly survivors lived at home, perceived their QOL as acceptable, and wanted to be readmitted to the ICU if necessarily. In older patients, age alone is a poor indicator of the possible value to be gained from an ICU admission.