0
June 23, 1993, Vol 269, No. 24 >
ARTICLE | June 23, 1993

Long-term Outcome of Critically III Elderly Patients Requiring Intensive Care FREE

Lakshmipathi Chelluri, MD; Michael R. Pinsky, MD; Michael P. Donahoe, MD; Ake Grenvik, MD
[+] Author Affiliations

Reprint requests to Scaife Hall, Room 608, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 (Dr Chelluri).


JAMA. 1993;269(24):3119-3123. doi:10.1001/jama.1993.03500240063027
Text Size: A A A
Published online
Article
References

Objective.  —To evaluate the long-term mortality and morbidity of critically ill elderly patients requiring intensive care.

Design.  —Prospective comparison of outcome of critically ill patients aged 75 years and older with patients aged 65 to 74 years.

Patients.  —Critically ill patients aged 65 years and older who required intensive care and who were recruited during a 3-month period.

Main Outcome Measures.  —Duration of hospitalization, hospital charges, procedures used in the intensive care unit, mortality in the hospital and during the follow-up period, and quality of life of survivors during the follow-up period.

Results.  —Ninety-seven patients were included in the study; 54 were 75 years or older and 43 were aged 65 to 74 years. No significant difference was noted between the two groups for length of stay in the hospital, hospital charges, or mortality at 1 year. Severity of illness, as assessed by Acute Physiology and Chronic Health Evaluation score at the time of intensive care unit admission, was a better predictor of survival than age. Quality of life, as assessed by activities of daily living, perceived quality of life, and Center for Epidemiologic Studies—Depression score, were not significantly different in either group at 1, 6, and 12 months after discharge from the hospital. Most patients in both groups described their quality of life as adequate and were willing to receive intensive care again, if necessary.

Conclusion.  —Age alone is not an adequate predictor of long-term survival and quality of life in critically ill elderly patients.(JAMA. 1993;269:3119-3123)

REFERENCES

1 +
Martin L.  Population aging policies in East Asia and the United States. Science . 1991;;251:527-532.
2 +
Rowe JW, Grossman E, Bond E.  Academic geriatrics for the year 2000: an institute of medicine report. N Engl J Med . 1987;;316:1425-1428.
3 +
Le Gall JR, Brun-Buisson C, Trunet P, Latournerie J, Chantereau S, Rapin M.  Influence of age, previous health status, and severity of acute illness on outcome from intensive care. Crit Care Med . 1982;;10:575-577.
4 +
Campion EW, Mulley AG, Goldstein RL, Barnett GO, Thibault E.  Medical intensive care for the elderly. JAMA . 1981;;246:2052-2056.
5 +
Cullen DJ, Keene R, Waternaux C, Kunsman JM, Caldera DL, Peterson H.  Results, charges and benefits of intensive care for critically ill patients: update 1983. Crit Care Med . 1984;;12:102-106.
6 +
Potgieter PD, Rosenthal E, Benatar SR.  Immediate and long-term survival in patients admitted to a respiratory ICU. Crit Care Med . 1985;;13:798-802.
7 +
McClish DK, Powell SH, Montenegro H, Nochomovitz M.  The impact of age on utilization of intensive care resources. J Am Geriatr Soc . 1987;;35: 983-988.
8 +
Mayer-Oakes SA, Oye RK, Leake B.  Predictors of mortality in older patients following intensive care: the importance of functional status. J Am Geriatr Soc . 1991;;39:862-868.
9 +
Mundt DJ, Gage RW, Lemeshow S, Pastides H, Teres D, Avrunin JS.  Intensive care unit patient follow-up: mortality, functional status, and return to work at six months. Arch Intern Med . 1989;;149:68-72.
10 +
Wu AW, Rubin HR, Rosen MJ.  Are elderly people less responsive to intensive care? J Am Geriatr Soc . 1990;;38:621-627.
11 +
Pesau B, Falger S, Berger E, et al.  Influence of age on outcome of mechanically ventilated patients in an intensive care unit. Crit Care Med . 1992;;20:489-492.
12 +
Callahan D.  Old age and new policy. JAMA . 1989;;261:905-906.
13 +
Levinsky NG.  Age as a criterion for rationing health care. N Engl J Med . 1990;;322:1813-1816.
14 +
Katz S, Downs TD, Cash HR, Grotz RC.  Progress in development of the index of ADL. Gerontologist . (Spring) 1970;;pt 1:20-30.
15 +
Knaus WA, Draper EA, Wagner DP, Zimmerman JE.  APACHE II: a severity of disease classification system. Crit Care Med . 1985;;13:818-829.
16 +
Keene AR, Cullen DJ.  Therapeutic Intervention Scoring System: update 1983. Crit Care Med . 1983;;11:1-3.
17 +
Patrick DL, Danis M, Southerland LI, Hong G.  Quality of life following intensive care. J Gen Intern Med . 1988;;3:218-223.
18 +
Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke B.  Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol . 1977;;106:203-214.
19 +
Shrout PE, Yager TJ.  Reliability and validity of screening scales: effect of reducing scale length. J Clin Epidemiol . 1989;;42:69-78.
20 +
Danis M, Gerrity MS, Southerland LI, Patrick DL.  A comparison of patient, family and physician assessment of the value of medical intensive care. Crit Care Med . 1988;;16:594-600.
21 +
Thibault GE, Mulley AG, Barnett GO, et al.  Medical intensive care: indications, interventions and outcomes. N Engl J Med . 1980;;302:938-942.
22 +
Detsky AS, Stricker SC, Mulley AG, Thibault EG.  Prognosis, survival, and the expenditure of hospital resources for patients in an intensive care unit. N Engl J Med . 1981;;305:667-672.
23 +
Byrick RJ, Mindorff C, McKee L, Mudge B.  Cost-effectiveness of intensive care for respiratory failure patients. Crit Care Med . 1980;;8:332-337.
24 +
Slayter MA, James OF, Moore PG, Leeder SR.  Costs, severity of illness and outcome in intensive care. Anaesthesiol Intensive Care . 1986;;14:381-389.
25 +
Sage WM, Hurst CR, Silverman JF, Bortz WM.  Intensive care for the elderly: outcome of elective and nonelective admissions. J Am Geriatr Soc . 1987;; 35:312-318.
26 +
Oye RK, Bellamy PE.  Patterns of resource consumption in medical intensive care. Chest . 1991;;99: 685-689.
27 +
Riley SA.  Outcome prediction in intensive therapy. Intensive Crit Care Digest . 1991;;10:62-63.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Martin L.  Population aging policies in East Asia and the United States. Science . 1991;;251:527-532.
2 +
Rowe JW, Grossman E, Bond E.  Academic geriatrics for the year 2000: an institute of medicine report. N Engl J Med . 1987;;316:1425-1428.
3 +
Le Gall JR, Brun-Buisson C, Trunet P, Latournerie J, Chantereau S, Rapin M.  Influence of age, previous health status, and severity of acute illness on outcome from intensive care. Crit Care Med . 1982;;10:575-577.
4 +
Campion EW, Mulley AG, Goldstein RL, Barnett GO, Thibault E.  Medical intensive care for the elderly. JAMA . 1981;;246:2052-2056.
5 +
Cullen DJ, Keene R, Waternaux C, Kunsman JM, Caldera DL, Peterson H.  Results, charges and benefits of intensive care for critically ill patients: update 1983. Crit Care Med . 1984;;12:102-106.
6 +
Potgieter PD, Rosenthal E, Benatar SR.  Immediate and long-term survival in patients admitted to a respiratory ICU. Crit Care Med . 1985;;13:798-802.
7 +
McClish DK, Powell SH, Montenegro H, Nochomovitz M.  The impact of age on utilization of intensive care resources. J Am Geriatr Soc . 1987;;35: 983-988.
8 +
Mayer-Oakes SA, Oye RK, Leake B.  Predictors of mortality in older patients following intensive care: the importance of functional status. J Am Geriatr Soc . 1991;;39:862-868.
9 +
Mundt DJ, Gage RW, Lemeshow S, Pastides H, Teres D, Avrunin JS.  Intensive care unit patient follow-up: mortality, functional status, and return to work at six months. Arch Intern Med . 1989;;149:68-72.
10 +
Wu AW, Rubin HR, Rosen MJ.  Are elderly people less responsive to intensive care? J Am Geriatr Soc . 1990;;38:621-627.
11 +
Pesau B, Falger S, Berger E, et al.  Influence of age on outcome of mechanically ventilated patients in an intensive care unit. Crit Care Med . 1992;;20:489-492.
12 +
Callahan D.  Old age and new policy. JAMA . 1989;;261:905-906.
13 +
Levinsky NG.  Age as a criterion for rationing health care. N Engl J Med . 1990;;322:1813-1816.
14 +
Katz S, Downs TD, Cash HR, Grotz RC.  Progress in development of the index of ADL. Gerontologist . (Spring) 1970;;pt 1:20-30.
15 +
Knaus WA, Draper EA, Wagner DP, Zimmerman JE.  APACHE II: a severity of disease classification system. Crit Care Med . 1985;;13:818-829.
16 +
Keene AR, Cullen DJ.  Therapeutic Intervention Scoring System: update 1983. Crit Care Med . 1983;;11:1-3.
17 +
Patrick DL, Danis M, Southerland LI, Hong G.  Quality of life following intensive care. J Gen Intern Med . 1988;;3:218-223.
18 +
Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke B.  Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol . 1977;;106:203-214.
19 +
Shrout PE, Yager TJ.  Reliability and validity of screening scales: effect of reducing scale length. J Clin Epidemiol . 1989;;42:69-78.
20 +
Danis M, Gerrity MS, Southerland LI, Patrick DL.  A comparison of patient, family and physician assessment of the value of medical intensive care. Crit Care Med . 1988;;16:594-600.
21 +
Thibault GE, Mulley AG, Barnett GO, et al.  Medical intensive care: indications, interventions and outcomes. N Engl J Med . 1980;;302:938-942.
22 +
Detsky AS, Stricker SC, Mulley AG, Thibault EG.  Prognosis, survival, and the expenditure of hospital resources for patients in an intensive care unit. N Engl J Med . 1981;;305:667-672.
23 +
Byrick RJ, Mindorff C, McKee L, Mudge B.  Cost-effectiveness of intensive care for respiratory failure patients. Crit Care Med . 1980;;8:332-337.
24 +
Slayter MA, James OF, Moore PG, Leeder SR.  Costs, severity of illness and outcome in intensive care. Anaesthesiol Intensive Care . 1986;;14:381-389.
25 +
Sage WM, Hurst CR, Silverman JF, Bortz WM.  Intensive care for the elderly: outcome of elective and nonelective admissions. J Am Geriatr Soc . 1987;; 35:312-318.
26 +
Oye RK, Bellamy PE.  Patterns of resource consumption in medical intensive care. Chest . 1991;;99: 685-689.
27 +
Riley SA.  Outcome prediction in intensive therapy. Intensive Crit Care Digest . 1991;;10:62-63.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems