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Minerva Anestesiologica 2017 June;83(6):598-609

DOI: 10.23736/S0375-9393.16.11434-8

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Critically ill octogenarians and nonagenarians: evaluation of long-term outcomes, posthospital 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


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BACKGROUND: The aim of this study was to investigate long-term outcomes, posthospital 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: In the study 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-year 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-year 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 necessary. In older patients, age alone is a poor indicator of the possible value to be gained from an ICU admission.


KEY WORDS: Critical illness - Aged, 80 and over - Long term adverse effects - Quality of life

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