Very old patients (older than 85 years) at a medical ICU: indications, interventions, outcome

Objective

The part of elderly people in the population has been increasing during the last decades. In 1995, 16% of the Middle-European population have been older than 65 years, up to the year 2010 there should be an increase up to 22%. German investigations have shown, that a 1/3 of the population older than 65 years are suffering from 3-4 chronic diseases, 98% of the population older than 80 years from one chronic disease.

Through those facts the number of old patients admitted to ICUs is increasing. Aim of following paper was to objective the treatment and outcome of very old patients (over 85 years) at a medical ICU of a general hospital over an 18-month period (1997-01-01 to 1998-06-30).

Results and outcome

899 patients had been admitted to the ICU during the study period, 48 (5.3%) older than 85 years. At admission the APACHE II-score ranked between 19 and 32. Indications had been mainly cardial (27), metabolic (8), gastrointestinal (6), outside CPR (5) and acute respiratory failure (2). 11 patients had been mechanical ventilated (1–8 days, mean 2.7 days), 6 patients received a cardiac pacemaker, 5 underwent endoscopical interventions, 4 thrombolysis (AMI, l00 mg Alteplase `front loaded'), 2 patients PTCA/IABP and one female patient ACBG.

Duration of stay had been 3.8 days (overall 3.9 days), mortality 27.7% (overall 14.8%).

Conclusion

Comorbidity and mortality had been higher in patients older than 85 years compared to all patients. 6 month after the ICU stay 24 patients (68.5%) were still alive. With good quality of life. Despite higher mortality very old patients benefit from ICU stay and interventions.