Literature DB >> 9377877

Limitation of therapeutic activity in elderly critically ill patients. Project for the Epidemiological Analysis of Critical Care Patients.

E Castillo-Lorente1, R Rivera-Fernández, G Vázquez-Mata.   

Abstract

OBJECTIVE: To establish whether the age of patients admitted into the intensive care unit (ICU) influences the amount of therapy received.
DESIGN: Observational, prospective, multicenter study.
SETTING: Eighty-six multidisciplinary ICUs in Spain, including coronary patients. PATIENTS: The patients (n = 8,838) were studied during a 6-month period between 1992 and 1993. Patients < 16 yrs of age and patients dying within the first 6 hrs were excluded from the study.
MEASUREMENTS AND MAIN RESULTS: We collected data on age, gender, type of diagnosis at the time of admission, severity level by Acute Physiology and Chronic Health Evaluation (APACHE) II and III, quality of life survey score, therapeutic activity during the first 24 hrs by Therapeutic Intervention Scoring System, and ICU and hospital mortality rates. In the sample of patients, 12.5% were > 75 yrs of age. Compared with younger patients, these patients had higher APACHE II (18.41 +/- 0.23 vs. 15.14 +/- 0.09 points, p < .001) and APACHE III (65.8 +/- 0.81 vs. 53.32 +/- 0.33 points, p < .001) scores, a higher quality of life survey score (i.e., worse quality of life, 7.19 +/- 0.19 vs. 3.86 +/- 0.05 points, p < .001), and a greater ICU mortality rate (21.9% vs. 15.3%, p < .00001) and hospital mortality rate (30.8% vs. 19.3%, p < .00001). However, patients > 75 yrs had a lower Therapeutic Intervention Scoring System score (19.83 +/- 0.28 vs. 21.17 +/- 0.12 points, p < .001). Multivariate analysis showed that once severity, need for mechanical ventilation, diagnostic group, and mortality rate were taken into account, there was less therapeutic activity in patients > 75 yrs of age.
CONCLUSIONS: Patients > 75 yrs of age represent a large proportion of patients in Spanish ICUs. Although their mortality rate and severity scores were higher than those values in younger patients, patients > 75 yrs of age received less therapy.

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Mesh:

Year:  1997        PMID: 9377877     DOI: 10.1097/00003246-199710000-00012

Source DB:  PubMed          Journal:  Crit Care Med        ISSN: 0090-3493            Impact factor:   7.598


  9 in total

1.  Intensive care unit use and mortality in the elderly.

Authors:  W Yu; A S Ash; N G Levinsky; M A Moskowitz
Journal:  J Gen Intern Med       Date:  2000-02       Impact factor: 5.128

Review 2.  [Medical geriatric aspects in intensive care therapy of elderly patients].

Authors:  U Müller-Werdan; T Klöss; M Meisel
Journal:  Med Klin Intensivmed Notfmed       Date:  2011-10-07       Impact factor: 0.840

Review 3.  Multi-organ renal failure in the elderly.

Authors:  G H Neild
Journal:  Int Urol Nephrol       Date:  2001       Impact factor: 2.370

4.  [Saving life and permitting death. Decision conflicts in intensive medicine].

Authors:  F Salomon
Journal:  Anaesthesist       Date:  2006-01       Impact factor: 1.041

Review 5.  [Outcome of intensive care].

Authors:  H P Schuster
Journal:  Med Klin (Munich)       Date:  1998-02-15

6.  "Oldest old" patients in intensive care: prognosis and therapeutic activity.

Authors:  Sophie Brunner-Ziegler; Georg Heinze; Martin Ryffel; Marion Kompatscher; Jörg Slany; Andreas Valentin
Journal:  Wien Klin Wochenschr       Date:  2007-02       Impact factor: 1.704

7.  Does gender impact intensity of care provided to older medical intensive care unit patients?

Authors:  Kathleen M Akgün; Terrence E Murphy; Katy L B Araujo; Peter H Van Ness; Margaret Pisani
Journal:  Crit Care Res Pract       Date:  2010-10-20

8.  Trends in short-term and 1-year mortality in very elderly intensive care patients in the Netherlands: a retrospective study from 2008 to 2014.

Authors:  Attila Karakus; Lenneke E M Haas; Sylvia Brinkman; Dylan W de Lange; Nicolette F de Keizer
Journal:  Intensive Care Med       Date:  2017-07-13       Impact factor: 17.440

9.  Comparison of the Course and Prognosis of Geriatric Patients Admitted to the Intensive Care Unit According to BMI and Albumin Values.

Authors:  Ozkan Onal; Gulten Ozgun
Journal:  Anesth Pain Med       Date:  2016-01-17
  9 in total

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