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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2011

Open Access 01-12-2011 | Review

The challenge of admitting the very elderly to intensive care

Authors: Yên-Lan Nguyen, Derek C Angus, Ariane Boumendil, Bertrand Guidet

Published in: Annals of Intensive Care | Issue 1/2011

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Abstract

The aging of the population has increased the demand for healthcare resources. The number of patients aged 80 years and older admitted to the intensive care unit (ICU) increased during the past decade, as has the intensity of care for such patients. Yet, many physicians remain reluctant to admit the oldest, arguing a "squandering" of societal resources, that ICU care could be deleterious, or that ICU care may not actually be what the patient or family wants in this instance. Other ICU physicians are strong advocates for admission of a selected elderly population. These discrepant opinions may partly be explained by the current lack of validated criteria to select accurately the patients (of any age) who will benefit most from ICU hospitalization. This review describes the epidemiology of the elderly aged 80 years and older admitted in the ICU, their long-term outcomes, and to discuss some of the solutions to cope with the burden of an aging population receiving acute care hospitalization.
Literature
1.
2.
Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr: Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 2000,284(21):2762–2770. 10.1001/jama.284.21.2762PubMedCrossRef
3.
Bagshaw SM, Webb SA, Delaney A, George C, Pilcher D, Hart GK, Bellomo R: Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 2009,13(2):R45. 10.1186/cc7768PubMedCentralPubMedCrossRef
4.
Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, de Keizer NF, Kersten A, Linde-Zwirble WT, Sandiumenge A, Rowan KM: Variation in critical care services across North America and Western Europe. Crit Care Med 2008,36(10):2787–2793. e1–9 10.1097/CCM.0b013e318186aec8PubMedCrossRef
5.
6.
Blot S, Cankurtaran M, Petrovic M, Vandijck D, Lizy C, Decruyenaere J, Danneels C, Vandewoude K, Piette A, Vershraegen G, Van Den Noortgate N, Peleman R, Vogelaers D: Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: a comparison between middle-aged, old, and very old patients. Crit Care Med 2009,37(5):1634–1641. 10.1097/CCM.0b013e31819da98ePubMedCrossRef
7.
Rasmussen JN, Rasmussen S, Gislason GH, Abildstrom SZ, Schramm TK, Torp-Pedersen C, Kober L, Diderichsen F, Osler M, Madsen M: Persistent socio-economic differences in revascularization after acute myocardial infarction despite a universal health care system-a Danish study. Cardiovasc Drugs Ther 2007,21(6):449–457. 10.1007/s10557-007-6058-7PubMedCrossRef
8.
Garrouste-Orgeas M, Boumendil A, Pateron D, Aergerter P, Somme D, Simon T, Guidet B: Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: an observational, multicenter, prospective study. Crit Care Med 2009,37(11):2919–2928. 10.1097/CCM.0b013e3181b019f0PubMedCrossRef
9.
Nguyen HL, Saczynski JS, Gore JM, Goldberg RJ: Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes 2010,3(1):82–92. 10.1161/CIRCOUTCOMES.109.884361PubMedCentralPubMedCrossRef
10.
Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Eberli FR, Stuck AE, Gutzwiller F, Erne P: Age-related differences in the use of guideline-recommended medical and interventional therapies for acute coronary syndromes: a cohort study. J Am Geriatr Soc 2008,56(3):510–516. 10.1111/j.1532-5415.2007.01589.xPubMedCrossRef
11.
Lerolle N, Trinquart L, Bornstain C, Tadie JM, Imbert A, Diehl JL, Fagon JY, Guerot E: Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med 38(1):59–64.
12.
Fowler RA, Sabur N, Li P, Juurlink DN, Pinto R, Hladunewich MA, Adhikari NK, Sibbald WJ, Martin CM: Sex- and age-based differences in the delivery and outcomes of critical care. CMAJ 2007,177(12):1513–1519. 10.1503/cmaj.071112PubMedCentralPubMedCrossRef
13.
Blomkalns AL, Chen AY, Hochman JS, Peterson ED, Trynosky K, Diercks DB, Brogan GX Jr, Boden WE, Roe MT, Ohman EM, Gibler WB, Newby LK: Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. J Am Coll Cardiol 2005,45(6):832–837. 10.1016/j.jacc.2004.11.055PubMedCrossRef
14.
15.
de Rooij SE, Govers AC, Korevaar JC, Giesbers AW, Levi M, de Jonge E: Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc 2008,56(5):816–822. 10.1111/j.1532-5415.2008.01671.xPubMedCrossRef
16.
Tabah A, Philippart F, Timsit JF, Willems V, Francais A, Leplege A, Carlet J, Bruel C, Misset B, Garrouste-Orgeas M: Quality of life in patients aged 80 or over after ICU discharge. Crit Care 2010,14(1):R2. 10.1186/cc8231PubMedCentralPubMedCrossRef
17.
Roch A, Wiramus S, Pauly V, Forel JM, Guervilly C, Gainnier M, Papazian L: Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care 2011,15(1):R36. 10.1186/cc9984PubMedCentralPubMedCrossRef
18.
Boumendil A, Angus D, Guitonneau A, Menn A, Ginsburg C, Pateron D, Garrouste-Orgeas M, Somme D, Simon T, Aegerter P, Guidet B: Determinants and outcome of intensive care unit admission of very elderly patients in France: a multicenter cohort study. 22th ESICM meeting ed. Intensive Care Med Vienna 2009, S178.
19.
Barnato AE, Albert SM, Angus DC, Lave JR, Degenholtz HB: Disability among elderly survivors of mechanical ventilation. Am J Respir Crit Care Med 2011,183(8):1037–1042. 10.1164/rccm.201002-0301OCPubMedCentralPubMedCrossRef
20.
Desai SV, Law TJ, Needham DM: Long-term complications of critical care. Crit Care Med 2011,39(2):371–379. 10.1097/CCM.0b013e3181fd66e5PubMedCrossRef
21.
Cuthbertson BH, Roughton S, Jenkinson D, Maclennan G, Vale L: Quality of life in the five years after intensive care: a cohort study. Crit Care 2010,14(1):R6. 10.1186/cc8848PubMedCentralPubMedCrossRef
22.
Unroe M, Kahn JM, Carson SS, Govert JA, Martinu T, Sathy SJ, Clay AS, Chia J, Gray A, Tulsky JA, Cox CE: One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med 2010,153(3):167–75.PubMedCentralPubMedCrossRef
23.
Wunsch H, Guerra C, Barnato AE, Angus DC, Li G, Linde-Zwirble WT: Three-year outcomes for Medicare beneficiaries who survive intensive care. JAMA 2010,303(9):849–56. 10.1001/jama.2010.216PubMedCrossRef
24.
Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM: Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med 2011,183(12):1666–1673. 10.1164/rccm.201012-1961OCPubMedCrossRef
25.
Wunsch H, Nguyen YL, Angus DC: Smoothing the way: improving admission to discharge from the ICU. In Organization and Management of Intensive Care. European Society of Intensive Care Medicine edn. Edited by: Flatten H, Moreno RP, Putensen C, Rhodes A. Medizinisch Wissenschaftliche Verlagsgesellschaft; 2010:269–276.
26.
Mercier E, Giraudeau B, Ginies G, Perrotin D, Dequin PF: Iatrogenic events contributing to ICU admission: a prospective study. Intensive Care Med 2010,36(6):1033–7. 10.1007/s00134-010-1793-9PubMedCrossRef
27.
Pisani MA, Murphy TE, Araujo KL, Van Ness PH: Factors associated with persistent delirium after intensive care unit admission in an older medical patient population. J Crit Care 2010,25(3):540 e1–7.PubMedCrossRef
28.
Herridge MS: Legacy of intensive care unit-acquired weakness. Crit Care Med 2009,37(10 Suppl):S457–461.PubMedCrossRef
29.
Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, Gordon SM, Canonico AE, Dittus RS, Bernard GR, Ely EW: Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010,38(7):1513–1520. 10.1097/CCM.0b013e3181e47be1PubMedCentralPubMedCrossRef
30.
Boumendil A, Latouche A, Guidet B: On the benefit of intensive care for very old patients. Arch Intern Med 2011,171(12):1116–1117. 10.1001/archinternmed.2011.102PubMedCrossRef
31.
32.
Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, Burant C, Covinsky KE: Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc 2008,56(12):2171–2179. 10.1111/j.1532-5415.2008.02023.xPubMedCentralPubMedCrossRef
33.
Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J: A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med 1995,332(20):1338–1344. 10.1056/NEJM199505183322006PubMedCrossRef
34.
Kane RL: Finding the right level of posthospital care: "We didn't realize there was any other option for him.". JAMA 2011,305(3):284–293. 10.1001/jama.2010.2015PubMedCrossRef
35.
Ahmed NN, Pearce SE: Acute care for the elderly: a literature review. Popul Health Manag 2010,13(4):219–225. 10.1089/pop.2009.0058PubMedCrossRef
36.
Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B: Should elderly patients be admitted to the intensive care unit? Intensive Care Med 2007,33(7):1252–1262. 10.1007/s00134-007-0621-3PubMedCrossRef
37.
Sligl WI, Eurich DT, Marrie TJ, Majumdar SR: Age still matters: prognosticating short- and long-term mortality for critically ill patients with pneumonia. Crit Care Med 2010,38(11):2126–2132. 10.1097/CCM.0b013e3181eedaebPubMedCrossRef
38.
Farfel JM, Franca SA, Sitta Mdo C, Filho WJ, Carvalho CR: Age, invasive ventilatory support and outcomes in elderly patients admitted to intensive care units. Age Ageing 2009,38(5):515–520. 10.1093/ageing/afp119PubMedCrossRef
39.
Gill TM, Allore HG, Gahbauer EA, Murphy TE: Change in disability after hospitalization or restricted activity in older persons. JAMA 2010,304(17):1919–1928. 10.1001/jama.2010.1568PubMedCentralPubMedCrossRef
40.
Iwashyna TJ, Ely EW, Smith DM, Langa KM: Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010,304(16):1787–1794. 10.1001/jama.2010.1553PubMedCentralPubMedCrossRef
41.
Yende S, Angus DC, Ali IS, Somes G, Newman AB, Bauer D, Garcia M, Harris TB, Kritchevsky SB: Influence of comorbid conditions on long-term mortality after pneumonia in older people. J Am Geriatr Soc 2007,55(4):518–525. 10.1111/j.1532-5415.2007.01100.xPubMedCrossRef
42.
Mohan D, Angus DC: Thought outside the box: intensive care unit freakonomics and decision making in the intensive care unit. Crit Care Med 2010,38(10 Suppl):S637-S641.PubMedCrossRef
43.
Rodriguez-Molinero A, Lopez-Dieguez M, Tabuenca AI, de la Cruz JJ, Banegas JR: Physicians' impression on the elders' functionality influences decision making for emergency care. Am J Emerg Med 2010,28(7):757–765. 10.1016/j.ajem.2009.03.016PubMedCrossRef
Metadata
Title
The challenge of admitting the very elderly to intensive care
Authors
Yên-Lan Nguyen
Derek C Angus
Ariane Boumendil
Bertrand Guidet
Publication date
01-12-2011
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2011
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/2110-5820-1-29

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