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Is age a predictor of mortality in medical high-dependency units?

  • 1,
  • 1,
  • 1 and
  • 1
Critical Care201115 (Suppl 1) :P501

https://doi.org/10.1186/cc9921

  • Published:

Keywords

  • Final Model
  • Functional Status
  • Home Care
  • Medical Patient
  • Medical Diagnosis

Introduction

The population aged >65 years is set to rise by 32% by 2033. As resources are limited, difficult decisions regarding access to high-dependency care for the older person will become increasingly important. The aim of this study was to determine whether age is a predictor of mortality in patients admitted to an open medical high-dependency unit (MHDU).

Methods

A prospective observational cohort study of 100 consecutive patients admitted to a MHDU with a medical diagnosis over a 3-month period. The primary endpoint was 30-day mortality.

Results

Overall mortality at 30 days was 21% (n = 21). Forty-one per cent of patients were aged <65 years, 29% 65 to 74 years and 30% 75+ years. There were no significant differences in mortality between groups (12%, 31% and 23%, respectively). When considering APACHE II scores ≥25, there was no significant difference in mortality between age groups (35% <70 years (7/20) vs. 29% ≥70 years (4/14), P = 1.000). The final model at multivariable regression analysis identified that ≥2 organ support (odds ratio = 10.843, 95% CI = 3.281 to 35.836) and preadmission moderate/nursing home care (4.437, 95% CI = 1.053 to 18.697) were significantly associated with worse outcome. ROC curve analysis for death showed that APACHE II score was a moderate discriminator (area under the curve = 0.64, 95% CI = 0.53 to 0.75), and age (0.60, (0.48 to 0.72)) was a poor predictor for 30-day mortality. The majority of survivors (88%) were discharged at their preadmission functional status; those who declined in function were not significantly older than those who did not. See Figure 1.
Figure 1
Figure 1

Survival of high-risk (2+ organ support and high preadmission care levels) versus low-risk groups, split by age.

Conclusions

Age does not predict outcome from MHDU. Patients requiring ≥2 organ support and/or higher levels of preadmission home support had higher mortality. Selected elderly medical patients can be expected to have outcomes comparable with younger patients and should not be denied MHDU care.

Authors’ Affiliations

(1)
Russells Hall Hospital, Dudley, UK

Copyright

© Hood et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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