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

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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).

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References

  1. Wunsch H, Linde-Zwirble WT, Harrison DA, Barnato AE, Rowan KM, Angus DC (2009) Use of intensive care services during terminal hospitalizations in England and the United States. Am J Respir Crit Care Med 180:875–880. doi:10.1164/rccm.200902-0201OC

    Article  PubMed  Google Scholar 

  2. Bagshaw SM, Webb SA, Delaney A, George C, Pilcher D, Hart GK, Bellomo R (2009) Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 13:R45. doi:10.1186/cc7768

    Article  PubMed Central  PubMed  Google Scholar 

  3. Kaarlola A, Tallgren M, Pettilä V (2006) Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med 34:2120–2126

    Article  PubMed  Google Scholar 

  4. Boumendil A, Maury E, Reinhard I, Luquel L, Offenstadt G, Guidet B (2004) Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 30:647–654

    Article  PubMed  Google Scholar 

  5. Broslawski GE, Elkins M, Algus M (1995) Functional abilities of elderly survivors of intensive care. J Am Osteopath Assoc 95:712–717

    CAS  PubMed  Google Scholar 

  6. Boumendil A, Latouche A, Guidet B, ICE-CUB Study Group (2011) On the benefit of intensive care for very old patients. Arch Intern Med 171:1116–1117. doi:10.1001/archinternmed.2011.102

    Article  PubMed  Google Scholar 

  7. Garrouste-Orgeas M, Timsit JF, Montuclard L, Colvez A, Gattolliat O, Philippart F, Rigal G, Misset B, Carlet J (2006) Decision-making process, outcome, and 1 year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med 32:1045–1051

    Article  PubMed  Google Scholar 

  8. Hofhuis JG, van Stel HF, Schrijvers AJ, Rommes JH, Spronk PE (2011) Changes of health-related quality of life in critically ill octogenarians: a follow-up study. Chest 140:1473–1483. doi:10.1378/chest.10-0803

    Article  PubMed  Google Scholar 

  9. Tabah A, Philippart F, Timsit JF, Willems V, Français A, Leplège A, Carlet J, Bruel C, Misset B, Garrouste-Orgeas M (2010) Quality of life in patients aged 80 or over after ICU discharge. Crit Care 14:R2. doi:10.1186/cc8231

    Article  PubMed Central  PubMed  Google Scholar 

  10. Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonge B, Carlet J (2000) Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med 28:3389–3395

    Article  CAS  PubMed  Google Scholar 

  11. Chelluri L, Pinsky MR, Donahoe MP, Grenvik A (1993) Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 269:3119–3123

    Article  CAS  PubMed  Google Scholar 

  12. de Rooij SE, Govers AC, Korevaar JC, Giesbers AW, Levi M, de Jonge E (2008) 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 56:816–822. doi:10.1111/j.1532-5415.2008.01671.x

    Article  PubMed  Google Scholar 

  13. Merlani P, Chenaud C, Mariotti N, Ricou B (2007) Long-term outcome of elderly patients requiring intensive care admission for abdominal pathologies: survival and quality of life. Acta Anaesthesiol Scand 51:530–537

    Article  CAS  PubMed  Google Scholar 

  14. Chelluri L, Pinsky MR, Grenvik AN (1992) Outcome of intensive care of the “oldest-old” critically ill patients. Crit Care Med 20:757–761

    Article  CAS  PubMed  Google Scholar 

  15. Sjögren J, Thulin LI (2004) Quality of life in the very elderly after cardiac surgery: a comparison of SF-36 between long-term survivors and an age-matched population. Gerontology 50:407–410

    Article  PubMed  Google Scholar 

  16. 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

    Article  CAS  PubMed  Google Scholar 

  17. Udekwu P, Gurkin B, Oller D, Lapio L, Bourbina J (2001) Quality of life and functional level in elderly patients surviving surgical intensive care. J Am Coll Surg 193:245–249

    Article  CAS  PubMed  Google Scholar 

  18. Andersen FH, Flaatten H, Klepstad P, Romild U, Kvåle R (2015) Long-term survival and quality of life after intensive care for patients 80 years of age or older. Ann Intensive Care 5:53. doi:10.1186/s13613-015-0053-0

    Article  PubMed  Google Scholar 

  19. Roch A, Wiramus S, Pauly V, Forel JM, Guervilly C, Gainnier M, Papazian L (2011) Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care 15:R36. doi:10.1186/cc9984

    Article  PubMed Central  PubMed  Google Scholar 

  20. Sacanella E, Pérez-Castejón JM, Nicolás JM, Masanés F, Navarro M, Castro P, López-Soto A (2011) Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study. Crit Care 15:R105. doi:10.1186/cc10121

    Article  PubMed Central  PubMed  Google Scholar 

  21. Khouli H, Astua A, Dombrowski W, Ahmad F, Homel P, Shapiro J, Singh J, Nallamothu R, Mahbub H, Eden E, Delfiner J (2011) Changes in health-related quality of life and factors predicting long-term outcomes in older adults admitted to intensive care units. Crit Care Med 39:731–737. doi:10.1097/CCM.0b013e318208edf8

    Article  PubMed  Google Scholar 

  22. Lieberman D, Nachshon L, Miloslavsky O, Dvorkin V, Shimoni A, Lieberman D (2009) How do older ventilated patients fare? A survival/functional analysis of 641 ventilations. J Crit Care 24:340–346. doi:10.1016/j.jcrc.2009.01.015

    Article  PubMed  Google Scholar 

  23. Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, Tayler C, Porterfield P, Sinuff T, Simon J, ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team; Canadian Researchers at the End of Life Network (CARENET) (2013) Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med 173:778–787. doi:10.1001/jamainternmed.2013.180

    Article  PubMed  Google Scholar 

  24. Garrouste-Orgeas M, Tabah A, Vesin A, Philippart F, Kpodji A, Bruel C, Grégoire C, Max A, Timsit JF, Misset B (2013) The ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over. Intensive Care Med 39:1574–1583. doi:10.1007/s00134-013-2977-x

    Article  CAS  PubMed  Google Scholar 

  25. Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, Davido A, Masmoudi R, Doumenc B, Pateron D, Garrouste-Orgeas M, Somme D, Simon T, Aegerter P, Guidet B, ICE-CUB study group (2012) Variability of intensive care admission decisions for the very elderly. PLoS ONE 7:e34387. doi:10.1371/journal.pone.0034387

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Huynh TN, Kleerup EC, Wiley JF, Savitsky TD, Guse D, Garber BJ, Wenger NS (2013) The frequency and cost of treatment perceived to be futile in critical care. JAMA Intern Med 173:1887–1894. doi:10.1001/jamainternmed.2013.10261

    Article  PubMed  Google Scholar 

  27. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300:1665–1673. doi:10.1001/jama.300.14.1665

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Goldstein J, Hubbard RE, Moorhouse P, Andrew MK, Mitnitski A, Rockwood K (2015) The validation of a care partner-derived frailty index based upon comprehensive geriatric assessment (CP-FI-CGA) in emergency medical services and geriatric ambulatory care. Age Ageing 44:327–330. doi:10.1093/ageing/afu161

    Article  PubMed  Google Scholar 

  29. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381:752–762. doi:10.1016/S0140-6736(12)62167-9

    Article  PubMed  Google Scholar 

  30. Evans SJ, Sayers M, Mitnitski A, Rockwood K (2014) The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment. Age Ageing 43:127–132. doi:10.1093/ageing/aft156

    Article  PubMed  Google Scholar 

  31. Ware JE (1996) The SF-36 health survey. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials, 2nd edn. Lippincott-Raven, Philadelphia, pp 337–345

    Google Scholar 

  32. Rogers J, Ridley S, Chrispin P, Scotton H, Lloyd D (1997) Reliability of the next of kin’s estimates of critically ill patient’s quality of life. Anaesthesia 52:1137–1143

    Article  CAS  PubMed  Google Scholar 

  33. Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, Joseph L, Brown JP, Murray TM, Murray TM, Adachi JD, Hanley DA, Papadimitropoulos E, The Canadian Multicentre Osteoporosis Study Research Group (2000) Canadian normative data for the SF-36 health survey. CMAJ 163:265–271

    PubMed Central  CAS  PubMed  Google Scholar 

  34. Wyrwich KW, Metz SM, Kroenke K, Tierney WM, Babu AN, Wolinsky FD (2007) Measuring patient and clinician perspectives to evaluate change in health-related quality of life among patients with chronic obstructive pulmonary disease. J Gen Intern Med 22:161–170

    Article  PubMed Central  PubMed  Google Scholar 

  35. Lloyd CB, Nietert PJ, Silvestri GA (2004) Intensive care decision making in the seriously ill and elderly. Crit Care Med 32:649–654

    Article  PubMed  Google Scholar 

  36. van Buuren S (2007) Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16:219–242

    Article  PubMed  Google Scholar 

  37. SAS Institute Inc (2014) SAS/STAT® 13.2 User’s Guide. SAS Institute, Cary

    Google Scholar 

  38. Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, Majumdar SR (2014) Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 186:E95–E102. doi:10.1503/cmaj.130639

    Article  PubMed Central  PubMed  Google Scholar 

  39. Le Maguet P, Roquilly A, Lasocki S, Asehnoune K, Carise E, Saint Martin M, Mimoz O, Le Gac G, Somme D, Cattenoz C, Feuillet F, Malledant Y, Seguin P (2014) Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med 40:674–682. doi:10.1007/s00134-014-3253-4

    PubMed  Google Scholar 

  40. Rockwood K, Mitnitski A, Song X, Steen B, Skoog I (2006) Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc 54:975–979

    Article  PubMed  Google Scholar 

  41. Taneja S, Rutenberg A, Mitnitski A, Rockwood K (2014) A dynamical network model for frailty-induced mortality. Bull Am Phys Soc 59(1):J11–J17

    Google Scholar 

  42. de Rooij SE, Abu-Hanna A, Levi M, de Jonge E (2007) Identification of high-risk subgroups in very elderly intensive care unit patients. Crit Care 11:R33

    Article  PubMed Central  PubMed  Google Scholar 

  43. Lown DJ, Knott J, Rechnitzer T, MacIsaac C (2013) Predicting short-term and long-term mortality in elderly emergency patients admitted for intensive care. Crit Care Resusc 15:49–55

    PubMed  Google Scholar 

  44. Turnbull AE, Krall JR, Ruhl AP, Curtis JR, Halpern SD, Lau BM, Needham DM (2014) A scenario-based, randomized trial of patient values and functional prognosis on intensivist intent to discuss withdrawing life support. Crit Care Med 42:1455–1462. doi:10.1097/CCM.0000000000000227

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

Funded by the Canadian Institutes of Health Research.

Author information

Authors and Affiliations

  1. Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada

    Daren K. Heyland, Xuran Jiang & Andrew G. Day

  2. Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada

    Allan Garland

  3. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Sean M. Bagshaw

  4. Departments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Deborah Cook

  5. Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada

    Kenneth Rockwood

  6. Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, Canada

    Henry T. Stelfox

  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

  8. Interdepartmental Division of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada

    Robert A. Fowler

  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 F. Turgeon

  10. Interdepartment Division of Critical Care, University of Toronto and St Michael’s Hospital, Toronto, Canada

    Karen Burns

  11. Critical Care Program, Queens University Kingston, Kingston, ON, Canada

    John Muscedere

  12. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, Canada

    Jim Kutsogiannis

  13. Département de Médecine, Centre de recherche de l’Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada

    Martin Albert

  14. Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada

    Sangeeta Mehta

Authors
  1. Daren K. Heyland
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  2. Allan Garland
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  3. Sean M. Bagshaw
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  4. Deborah Cook
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  5. Kenneth Rockwood
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  6. Henry T. Stelfox
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  7. Peter Dodek
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  8. Robert A. Fowler
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  9. Alexis F. Turgeon
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  10. Karen Burns
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  11. John Muscedere
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  12. Jim Kutsogiannis
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  13. Martin Albert
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  14. Sangeeta Mehta
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  15. Xuran Jiang
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  16. Andrew G. Day
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Corresponding author

Correspondence to Daren K. Heyland.

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Conflicts of interest

The protocol was endorsed and conducted in collaboration with the Canadian Critical Care Trials Group (www.ccctg.ca) and the Canadian Researchers at the End of Life Network (www.thecarenet.ca). The study was funded by the Canadian Institutes of Health Research which played no role in the design, conduct, analysis, interpretation of results or decision to publish. Dr Heyland and Mr. Day have had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr. Cook is a Canada Research Chair of the Canadian Institutes of Health Research. Kenneth Rockwood is supported by the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research. Dr. Turgeon is a Clinician Scientist of the Fonds de Recherche du Québec-Santé (FRQ-S). Dr. Bagshaw holds a Canada Research Chair in Critical Care Nephrology and is supported by a Clinical Investigator Award from Alberta Innovates-Health Solutions (AI-HS). Dr. Fowler is a Clinician Scientist of the Heart and Stroke Foundation (Ontario). Dr Burns holds a CIHR Clinician Scientist Award and a Ministry of Research and Innovation Early Researcher Award. No investigators report financial or other conflicts of interest.

Additional information

On behalf of the Canadian Critical Care Trials Group and the Canadian Researchers at the End of Life Network (CARENET).

Take-home message: One-quarter of patients aged 80 years or older admitted to ICU survived and returned to baseline levels of physical function at one year. Routine assessment of baseline physical function and frailty status could aid in prognostication and informed decision-making for very old critically ill patients.

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Heyland, D.K., Garland, A., Bagshaw, S.M. et al. Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study. Intensive Care Med 41, 1911–1920 (2015). https://doi.org/10.1007/s00134-015-4028-2

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