Elderly patients and nursing workload in intensive care units

As the population ages, the number of diseases related to the elderly increases, having as a consequence an acute complication status that requires ICU admission. Considering that these units are complex and costly, admission of the elderly to ICUs is controversial and is presumed to have a high nursing workload. Based on that, the aims of this study were to compare the nursing workload (Nursing Activities Score (NAS)) and the severity of illness (SAPS II) among elderly patients and to identify predictors of the nursing workload in ICUs. In a prospective study, data were collected from 71 elderly patients (≥60 years) admitted to ICUs in three hospitals in the city of São Paulo, Brazil, in 2004. The sample was divided according to age into three groups: 60–69 years, 70–79 years and ≥80 years. Statistic analyses were carried out to verify the relation among the variables. The Student t test and ANOVA tests, with Bonferroni correction, and multiple logistic forward regression were used. The level of significance was P < 0.05. Most of the patients (n = 71) were males (53.5%), and their mean age was 75.8 years (range: 60–97 years). Medical treatment (74%) and admissions from the emergency room (40.8%) were predominant. The mean length of stay in the ICU was 13.9 days (range: 1–53 days) and the mortality rate was 17.0%. The mean NAS according to the groups (that is, 60–69 years, 70–79 years and ≥80 years) were, respectively, 72.4%, 74.3% and 71.9%, and the mean risks of mortality were 15.8%, 24.8% and 35.6%. The NAS major average was found among patients aged 70–79 years, but was not statistically significant (P = 0.842). Among the nursing workload predictors were found age, type of admission and severity. It was observed that the severity and risk of mortality increased as patients aged. This was not the same for nursing workload. Surgical treatment and the least LOS increased the workload for the elderly in the ICU. The results indicate the need for discussing intensive treatment of the elderly so that age is not a discriminating factor.