Abstract
Objective
The purpose of this study was to examine characteristics and outcome of the old, very old and oldest-old ICU patients
Design
This is a cohort study.
Setting
The study was set in a ten-bed medical ICU in a university hospital.
Participants
There were 410 patients classified in three subgroups: old, 75–79 years (n=184; 44.4%), very old, 80–84 (n=137, 33.4%) and the oldest-old, ≥85 (n=91; 22.2%).
Measurements
Underlying medical conditions, organ dysfunction, severity of illness, length of stay, use of mechanical ventilation, therapeutic activity and nosocomial infections were recorded. Multivariate analysis was conducted to identify risk factors for ICU and long-term mortality.
Results
Characteristics at ICU admission did not differ among the three groups. ICU length of stay, therapeutic activity, mechanical ventilation and nosocomial infection(s) decreased with age. ICU survival rates for those below 75, 75–79, 80–84 and over 85 years were 80, 68, 75 and 69%, respectively; survival rates at 3 months were 54, 56 and 51%, respectively. APACHE II score [odds ratio (OR): 1.11] was identified as the only factor associated with ICU mortality, and age (OR: 2.17, for patients ≥85 years old and 1.82, for patients 80–84 years old) and limitation of activity before admission (OR: 1.74) as factors associated with long-term mortality.
Conclusion
In a population of patients ≥75 years old, very old age is not directly associated with ICU mortality. After ICU discharge, deaths occurred predominantly during the first 3 months: age and prior limitation of activity were associated with the risk of dying.
Similar content being viewed by others
References
Observatoire Régional de la Santé en Ile-de-France. La morbidité hospitalière en Ile-de-France (1992) Les hospitalisations en urgence. Observatoire Régional de la Santé, Paris, p 120
Chelluri L, Pinsky MR, Donahoe MP, Grenvik A (1993) Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 269:3119–3123
Bayer AJ, Chadha JS, Farag RR, Pathy MS (1986) Changing presentation of myocardial infarction with increasing old age. J Am Geriatr Soc 34:263–266
Chelluri L, Grenvik A, Silverman M (1995) Intensive care for critically ill elderly: mortality, costs, and quality of life. Arch Intern Med 155:1013–1022
Ridley S, Jackson R, Findlay J, Wallace P (1990) Long-term survival after intensive care. BMJ 301:1127–1130
Mayer-Oakes S, Oye R, Leake B (1991) Predictors of mortality in older patients following medical intensive care. J Am Geriatr Soc 39:862–868
Rockwood K, Noseworthy TW, Gibney RTN, Konopad E, Shustack A, Stollery D, Johnston R, Grace M (1993). One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med 21:687–691
Nicolas F, Le Gall JR, Alperovitch A, Loirat P, Villers D (1987) Influence of patient’s age on survival, level of therapy and length of stay in intensive care units. Intensive Care Med 13:9–13
McClish DK, Powell SH, Montenegro H, Nochomovitz M (1987) The impact of age on utilization of intensive care resources. J Am Geriatr Soc 35:983–988
McLean RF, McIntosh JD, Kung GY, Leung DM, Byrick RJ (1985) Outcome of respiratory intensive care for the elderly. Crit Care Med 13:625–629
Grenrot C, Norberg A, Hakansson S (1986) Intensive care of the elderly—a retrospective study. Acta Anaesthesiol Scand 30:703–708
Campion EW, Mulley AG, Goldstein RL, Barnett GO, Thibault GE (1981) Medical intensive care for the elderly. JAMA 246:2052–2056
French Muticenter Group of ICU Research (1989) Factors related to outcome in intensive care: French multicenter study. Crit Care Med 17:305–308
Chalfin DB, Carlon CG (1990). Age and utilization of intensive care unit resources of critically ill cancer patients. Crit Care Med 18:694–698
Fedullo AY, Swinburne AJ (1983) Relationship of patient age to cost and survival in a medical ICU. Crit Care Med 11:155–159
Wu AW, Rubin HR, Rosen MJ (1990) Are elderly people less responsive to intensive care? J Am Geriatr Soc 38:621–627
Zaren B, Bergstrom R (1988) Survival of intensive care patients I: prognostic factors from the patient’s medical history. Acta Anaesthesiol Scand 32:93–100
Tran DP, Groeneveld AB, Van der Meulen J, Nauta JJ, Strack van Schijndel RJ, Thijs LG (1990) Age, chronic disease, sepsis, organ system failure and mortality in a medical intensive care unit. Crit Care Med 18:474–479
Sage WM, Hurst CR, Silverman JF, Bortz WM 2nd (1987) Intensive care for the elderly: outcome of elective and non elective admissions. J Am Geriatr Soc 35:312–318
Mahul P, Perrot D, Tempelhoff G, Gaussorgues P, Jospe R, Ducreux JC, Dumont A, Motin J, Auboyer C, Robert D (1991) Short- and long-term prognosis, functional outcome following ICU for elderly. Intensive Care Med 17:7–10
Kass JE, Castriotta RJ, Malakoff F (1992) Intensive care unit outcome in the very elderly. Crit Care Med 20:1666–1671
Chelluri L, Pinsky MR, Grenvik ANA (1992) Outcome of intensive care of the “oldest-old” critically ill patients. Crit Care Med 20:757–761
Van den Noorgate N, Vogelaers D, Afschrift M, Colardyn F (1999) Intensive care for very elderly patients: outcome and risk factors for in-hospital mortality. Age Ageing 28:253–256
Knaus WA, Wagner DP, Zimmerman JE, Draper EA (1993) Variations in mortality and length of stay in intensive care units. Ann Intern Med 118:753–761
Le Gall JR, Brun-Buisson C, Trunet P, Latournerie J, Chantereau S, Rapin M (1982) Influence of age, previous health status, and severity of acute illness on outcome from intensive care. Crit Care Med 10:575–577
Djaiani G, Ridley S (1997) Outcome of intensive care in the elderly. Anaesthesia 52:1130–1136
Hamel MB, Davis RB, Teno JM, Knaus WA, Lynn J, Harrell F Jr, Galanos AN, Wu AW, Philips RS (1999) Older age, aggressiveness of care, and survival for seriously ill hospitalized adults. Ann Intern Med 131:721–728
McCabe WR, Jackson GG (1962) Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med 110:847–855
Fagon JY, Chastre J, Novara A, Medioni P, Gibert C (1993) Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: the ODIN model. Intensive Care Med 19:137–144
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
Société de Réanimation de Langue Française (1986) Utilisation de l’indice de gravité simplifié et du système Omega. Mise à jour 1986, Commision d’Evaluation de la Société de Réanimation de Langue Française. Réanimations Soins Intensifs Med Urg 2:219–221
Girou E, Stephan F, Novara A, Safar M, Fagon JY (1998) Risk factors and outcome of nosocomial infections: results of a matched case—control study of ICU patients. Am J Respir Crit Care Med 157:1151–1158
Nuckton TJ, List ND (1995) Age as a factor in critical care unit admissions. Arch Intern Med 155:1087–1092
Chalfin DB (1993). Outcome assessment in elderly patients with critical illness and respiratory failure. Clin Chest Med 14:583–589
Castillo-Lorente E, Rivera-Fernandez R, Vasquez-Mata G (1997). Limitation of therapeutic activity in elderly critical patients. Crit Care Med 25:1643–1648
Ely EW, Wheeler AP, Thompson T, Ancukiewicz M, Steinberg KP, Bernard GR (2002). Recovery rate and prognosis in older persons who develop acute lung injury and acute respiratory distress syndrome. Ann Intern Med 136:25–36
Author information
Authors and Affiliations
Corresponding author
Additional information
An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-003-1845-5)
Rights and permissions
About this article
Cite this article
Somme, D., Maillet, JM., Gisselbrecht, M. et al. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29, 2137–2143 (2003). https://doi.org/10.1007/s00134-003-1929-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-003-1929-2