Therapeutic activity in elderly medical intensive care patients

Full text

Introduction

Previous studies showed a limitation of therapeutic activity in elderly critically ill patients. We analysed whether the age of patients admitted to our medical intensive care unit (ICU) influenced the quantity of therapy provided.

Patients and methods

All patients admitted to our 12-bed non-coronary medical ICU between 8/95 and 7/99 were enrolled in the study. Prospectively the reason for ICU admission, acute diagnoses, co-morbid illness, diagnostic procedures, daily APACHE II and TISS scores, ICU and hospital mortality rates were documented. Contingency tables were analysed using chi square test, continuous variables were compared using Mann-Whitney U test.

Results

2127 patients were studied; mean age was 57± 18.6 (± SD) years, median 59, range 18-101 years, 45% were female. Mean ICU length of stay was 7± 12.8 days, median 3. Mean APACHE II score (first 24 h) was 18.6± 12.3. Mean TISS score (mean value of all days spent on the ICU) was 25.8± 13.3. ICU mortality was 23.6%, hospital mortality was 31.7%. 432 patients (20.3%) were ≥ 75 years of age. Compared with younger patients these patients had higher APACHE II scores (23.2± 11.8 vs 17.5± 12.1, P=0.0005), higher modified APACHE II scores (age points subtracted) (17.2± 11.8 vs 15.2± 11.6, P=0.001), higher mean TISS scores (28.3± 12.2 vs 25.2± 13.5, P=0.0005), a higher ICU mortality rate (21.5% vs 31.7%, P=0.0005) and hospital mortality rate (28.4% vs 44.4%, P=0.0005). No differences between the two age groups were noted in the number of days spent on a respirator or renal replacement therapy and in the frequency of diagnostic procedures, like ultrasound and endoscopy. Multivariate analysis showed that after adjustment for disease severity, mechanical ventilation and mortality rates patients ≥ 75 years of age received the same amount of therapy as assessed by daily TISS points.

Conclusion

In contrast to other investigators we found no limitation of therapeutic activity in our sample of elderly medical ICU patients.