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Intensive Care Med. 2015 Nov;41(11):1911-20. doi: 10.1007/s00134-015-4028-2. Epub 2015 Aug 26.

Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study.

Author information

1
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada. dkh2@queensu.ca.
2
Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada. agarland@hsc.mb.ca.
3
Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. bagshaw@ualberta.ca.
4
Departments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. debcook@mcmaster.ca.
5
Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada. Kenneth.Rockwood@dal.ca.
6
Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, Canada. tstelfox@ucalgary.ca.
7
Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. peter.dodek@ubc.ca.
8
Interdepartmental Division of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada. Rob.Fowler@sunnybrook.ca.
9
Division of Critical Care Medicine and Population Health and Optimal Health Practices Research Unit, Centre Hospitalier Universitaire (CHU) de Québec and Université Laval, Quebec, QC, Canada. Alexis.Turgeon@fmed.ulaval.ca.
10
Interdepartment Division of Critical Care, University of Toronto and St Michael's Hospital, Toronto, Canada. burnsk@smh.ca.
11
Critical Care Program, Queens University Kingston, Kingston, ON, Canada. muscedej@kgh.kari.net.
12
Division of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, Canada. djk3@ualberta.ca.
13
Département de Médecine, Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada. m.albert@umontreal.ca.
14
Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada. SMehta@mtsinai.on.ca.
15
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada.

Abstract

PURPOSE:

Increasingly, very old patients are admitted to Intensive Care Units (ICUs). The objective of this study was to describe 12-month outcomes of these patients and determine which characteristics are associated with a return to baseline physical function 1 year later.

METHODS:

In this prospective cohort study in 22 Canadian hospitals, we recruited 610 patients aged 80 years or older who were admitted to ICU for at least 24 h. At baseline, we completed a comprehensive geriatric assessment and followed patients to determine 12-month survival and physical function. Our primary outcome was physical recovery from critical illness at 12 months, defined as being alive with Short Form-36 physical function score of at least 10 points, and not 10 or more points below baseline. We used regression analysis to examine factors associated with physical recovery.

RESULTS:

Patients were on average 84 years old (range 80-99). Mortality was 14% in ICU, 26% in hospital and 44% at 12 months after admission. Of 505 patients evaluable at 12 months, 26% achieved physical recovery. In the multivariable model, physical recovery was significantly associated with younger age, lower APACHE II score, lower Charlson comorbidity score, lower frailty index, lower baseline physical function score, and specific admission diagnoses.

CONCLUSIONS:

One-quarter of patients aged 80 years or older who are admitted to ICU survived and returned to baseline levels of physical function at 1 year. Routine assessment of baseline physical function and frailty status could aid in prognostication and informed decision-making for very old critically ill patients. (ClinicalTrials.gov number NCT01293708).

KEYWORDS:

Aged 80 and older; Critical illness; Follow up study; Frailty; Outcome assessment; Physical function

PMID:
26306719
DOI:
10.1007/s00134-015-4028-2
[Indexed for MEDLINE]

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