One-year survival and functional outcome in critically ill elderly patients

Introduction

The number of elderly ICU patients is increasing [1] but limited outcome data are available. In this pilot study we evaluated survival and quality-of-life indicators in ICU patients aged ≥65 years.

Method

Retrospective analysis of admissions between 1996 and 2005 defined the number of elderly ICU patients. Then between 2004 and 2006, consecutive patients ≥65 years admitted to general (631), cardiothoracic (722) or neurological (118) critical care units requiring ≥24 hours of ≥2 organ support were identified. Patients were divided into 'young' (age 65–74 years, n = 733) and 'old' (age ≥75 years, n = 738). Age, sex, organ support, diagnosis, and referral source were recorded. Patients were followed-up 1 year after discharge. A standard telephone interview of a random sample of survivors (young n = 15, old n = 22) assessed performance status and the EQ5D health-related quality of life [2]. Data were analysed using Kaplan–Meier and log rank.

Results

From 1996 to 2005, 47.3% (4,717) of admissions to the ICU were aged ≥65 years; 24.0% (2,393) were ≥75 years. One-year survival of the young group (51.8%) was significantly (P < 0.001) better than the old group (37.9%). However, in those receiving ≥3 organ support (young n = 197; old n = 199), this significance is lost (42.2% vs 32.6%, P > 0.2). Younger elective surgical patients had better survival than older (79.4%, n = 196 vs 64.5%, n = 173). There was no survival difference between young and old after emergency surgery (52.9%, n = 57 vs 50.4%, n = 85; P > 0.5). There was no difference between 'young' and 'old' groups in the EQ5D weighted health index (0.67 ± 0.30 vs 0.62 ± 0.29, P > 0.5) or performance status scores (1.73 ± 0.96 vs 1.72 ± 0.98, P > 0.5). The EQ5D scores of survivors were lower than matched population norms (0.64 vs 0.76, P < 0.01).

Conclusion

Survival is worse in older ICU patients, although initial data suggest no difference in functional outcome. Survivors have lower quality-of-life scores than population norms [3]. Further work is pending.