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Am J Geriatr Psychiatry. 2019 Apr;27(4):446-454. doi: 10.1016/j.jagp.2018.12.002. Epub 2018 Dec 6.

Aging and Postintensive Care Syndrome- Family: A Critical Need for Geriatric Psychiatry.

Author information

1
Department of Psychiatry (PS, YNPK, SW), Indiana University School of Medicine, Indianapolis.
2
Department of Psychiatry (PS, YNPK, SW), Indiana University School of Medicine, Indianapolis; Center of Health Innovation and Implementation Science (SW), Center for Translational Science and Innovation, Indianapolis; Sandra Eskenazi Center for Brain Care Innovation (SW, BK), Eskenazi Hospital, Indianapolis. Electronic address: sophwang@iupui.edu.
3
Indiana University Center of Aging Research (SK, BK), Regenstrief Institute, Indianapolis; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine (SK, BK), Department of Medicine, Indiana University School of Medicine, Indianapolis.
4
Division of Geriatric Medicine and Gerontology (LS), University of Pittsburgh, Pittsburgh; Division of Pulmonary, Allergy, and Critical Care Medicine (LS), University of Pittsburgh, Pittsburgh.
5
Sandra Eskenazi Center for Brain Care Innovation (SW, BK), Eskenazi Hospital, Indianapolis; Indiana University Center of Aging Research (SK, BK), Regenstrief Institute, Indianapolis; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine (SK, BK), Department of Medicine, Indiana University School of Medicine, Indianapolis.

Abstract

Postintensive care syndrome-family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons. First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment compared with older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared with other geriatric populations. Second, as caregivers themselves age, caring for this unique burden can be more challenging compared with other geriatric populations. Third, evidence for models of care centered on patients with multimorbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multimorbidity and their caregivers. Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers.

KEYWORDS:

caregiver stress; cognitive impairment; critical care illness; delirium; post–intensive care syndrome–family

PMID:
30595492
PMCID:
PMC6431265
[Available on 2020-04-01]
DOI:
10.1016/j.jagp.2018.12.002

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