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

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
figure1

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.

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Correspondence to E Hood.

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Hood, E., Bhangu, A., Pandit, D. et al. Is age a predictor of mortality in medical high-dependency units?. Crit Care 15, P501 (2011). https://doi.org/10.1186/cc9921

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Keywords

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