Health-related quality of life in critically ill octogenarians: a long-term follow-up study

Introduction

Mortality after critical illness is higher and recovery is slower in the elderly compared with younger patients. Elderly patients recovering from critical illness may show reduced health-related quality of life (HRQOL) [1]. We studied the impact of ICU stay on HRQOL of octogenarians, and compared their HRQOL with the same age-matched general population.

Methods

We performed a long-term prospective study in a medical–surgical ICU. Patients ≥ 80 years (n = 129) admitted for >48 hours were included. We used the Short-Form 36 (SF-36) to evaluate HRQOL before ICU admission (using proxies), at ICU discharge and at hospital discharge and at 3, 6 and 12 months following ICU discharge. Furthermore we compared HRQOL before ICU admission and 12 months after ICU discharge with those of an age-matched general Dutch population. The Wilcoxon signed rank test was used for evaluating changes between two time points. To analyze individual changes over time, a MANOVA test was used, with Wilks' lambda as the multivariate test.

Results

Mortality was considerable in the 129 included octogenarians. Patients could be evaluated 6 months (n = 48) and 12 months (n = 27) after ICU discharge (11 patients were lost to follow-up, 70 patients died). All SF-36 dimensions changed significantly over time (all P < 0.001), with the exception of the role-emotional dimension. However, after an initial drop, HRQOL recovered to pre-ICU levels in all dimensions. The physical component scores changed significantly over time (all P < 0.001), whereas the mental component scores showed only a modest decline at ICU discharge but recovered rapidly and had improved to higher than baseline values with longer follow-up to 12 months after ICU discharge. The pre-admission HRQOL in surviving octogenarians was already lower when compared with the age-matched general population and remained so at 12 months after ICU discharge.

Conclusion

Critically ill octogenarians demonstrate a sharp decline of HRQOL during the ICU stay and a gradual improvement during the 6 months and 12 months following ICU discharge to baseline values. Recovery begins following ICU discharge to the general ward. This implies that intensive care treatment in patients ≥ 80 years is worthwhile.