Clinical characteristics, evolution and prognosis of elderly patients admitted to a medical intensive care unit

Background

The elderly currently represent up to 52% of patients admitted to ICUs, and have poorer prognosis when compared with younger patients. The clinical characteristics, evolution and prognosis of elder patients admitted to the ICU have not been studied in a recent national series of patients.

Patients and methods

We selected 112 (29.5%) patients older than 65 years out of 380 patients admitted to an ICU. We compared their clinical characteristics, evolution and prognosis with that of younger patients. The Acute Physiologic and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) were used as prognostic indexes.

Results

Fifty-four (48.1%) patients were women and 58 (51.8%) were men, and the mean age was 73.8 ± 5.9 years. The average ICU stay was 15.8 ± 19.2 days and 56 (50%) patients died. Compared with younger patients, elderly patients had a higher APACHE II score (21.9 ± 9.0 vs 15.9 ± 8.7, P < 0.001) and mean SOFA score (7.1 ± 4.56 vs 4.5 ± 4.80, P < 0.001). Moreover, urinary catheters were used more frequently (75% vs 63.7%, P = 0.002), as well as central venous catheters (74.1% vs 63.7%, P = 0.004), mechanical ventilation (63.4% vs 47.6%, P < 0,001), and pulmonary artery catheters (21.4% vs 13.7%, P = 0.012). Elder patients had a lower rate of pneumonias (5.4% vs 10.0%, P = 0.025) and a higher rate of urinary infections (18.8% vs 12.1%, P = 0.023). The mortality of elderly patients was higher (50% vs 31.3%, P < 0.001). Among elder patients, the APACHE II score (26.1 ± 9.5 vs 17.7 ± 6.0, P = 0.000), mean SOFA score (10.55 ± 3.41 vs 3.52 ± 2.29, P < 0.001), use of a central catheter (87.5% vs 60.7%, P = 0.001), dialysis (21.4% vs 5.4%, P = 0.013), mechanical ventilation (91.1% vs 35.7%, P < 0.001) and presence of septic shock (32.1% vs 8.9%, P = 0.002) were associated with worse prognosis.

Conclusion

Elder patients admitted to the ICU are more severely ill and have a higher number of organ dysfunctions as compared with younger patients. They have a worse prognosis despite the increased number of medical interventions.