Functional ability in younger and older elderlies after discharge from the intensive care unit. A prospective cohort

Abstract

ObjectiveTo compare the functional capacity of younger elderly individuals (60 to 79 years old) with that of older elderly individuals (≥ 80 years old) during the first 6 months after discharge from the intensive care unit.MethodsA multicenter prospective cohort study was conducted, in which data on intensive care unit admission and outcomes after hospital discharge (immediate post-discharge, after 3 months and after 6 months) were collected. Muscle strength was evaluated through the protocol of the Medical Research Council and dynamometry (handgrip); the ability to perform activities of daily life and functional independence were assessed by the Barthel index and the usual level of physical activity (International Physical Activity Questionnaire); and quality of life was assessed by the 12-Item Short-Form Health Survey Version 2.ResultsAmong the 253 patients included, 167 were younger elderly (between 61 and 79 years old), and 86 were older elderly (≥ 80 years old). During the sixth month of evaluation, the older elderlies presented a higher need for a caregiver (69.0% versus 49, 5%, p = 0.002). Functional capacity prior to intensive care unit admission and in the third month after discharge was lower in older elderlies than in younger ones (Barthel prior to the intensive care unit: 73.0 ± 30.0 versus 86.5 ± 22.6; p <0.001, Barthel in the third month: 63.5 ± 34.0 versus 71.5 ± 35.5, p = 0.03), as was the usual level of physical activity (International Physical Activity Questionnaire in the third month: active/very active 3.4% versus 18.3%, no physical activity 64.4% versus 39.7%, p < 0.001, and International Physical Activity Questionnaire in the sixth month: active/very active 5.8% versus 20.8%, no physical activity 69.2% versus 43.4%, p = 0.005). Older elderlies had lower muscle strength when assessed according to handgrip in both the dominant (14.5 ± 7.7 versus 19.9 ± 9.6, p = 0.008) and non-dominant limb (13.1 ± 6.7 versus 17.5 ± 9.1, p = 0.02). There were no differences in functional capacity loss or reported quality of life between the age groups.ConclusionAlthough there were great functional capacity losses after discharge from the intensive care unit in both age groups, there was no difference in the magnitude of functional capacity loss between younger (60 to 79 years) and older elderly individuals (≥ 80 years old) during the first 6 months after discharge from the intensive care unit.

Hand- och benstyrka vid intensivvårdsavdelning (IVA)-mottagning, -en retrospektiiv studie

“…Aktuell studie visade ett signifikant lägre värde vid test med handdynamometer för forskningspersonerna jämfört med matchade kontrollvärden, vilket överensstämmer med resultat från tidigare studie efter intensivvård där äldre personer (≥ 60 år) ingick i studien (Dietrich et al, 2017). Föreliggande studies medianvärde för handdynamometer var 30 kg, vid uppföljning tre månader efter intensivvård beskriven av Schandl et al (2011) var medelvärdet för handdynamometer 29 kg med utebliven signifikant förbättring vid uppföljning efter sex och tolv månader.…”

“…Det fanns en hög grad av funktionsnedsättning i axlar hos patienter sex månader efter intensivvård (Gustafson, Rowland, Watkinson, McKechnie, & Igo, 2018). Vid uppföljning tre och sex månader efter utskrivning från IVA hade personer ≥80 år, jämfört med personer 60 -79 år, en signifikant lägre handstyrka, båda gruppernas handstyrka var lägre än referensvärden (Dietrich, Cardoso, Vargas, Sanchez, Dutra, Moreira, Bessel, Robinson, Falavigna, & Teixeira, 2017). Vid mätning tre månader efter intensivvård konstaterades att 11 av 61 patienter hade pågående fysioterapikontakt.…”

Adaptação de longevos no domicílio após alta da unidade intensiva

“…19 The prognostic index (PI), which measures the severity of the disease and predicts the likelihood of death following ICU discharge and discharge from hospital, the Acute Physiology and Chronic Health Evaluation (APACHE), was used in most studies. [15][16][17][18][19][20][21][22] Older adults admitted to the ICU have poor short-term outcomes after hospital discharge, with high mortality rates. Good longterm results were found in those who survived for over a year.…”

“…19 It was shown in one research that of the 75 to 85-year-old group who survived prolonged ICU admission, 75% lived in their own homes before admission. 18 It is known that, for the long-term, changing environments can make their adaptive process even more difficult, as it will already present difficulties inherent to the recovery process itself and will also have to face it in an environment that is not the same. It is understood that all this can culminate in sadness, longing and generate an ineffective adaptation behavioral response.…”

“…It was revealed that all the elderly individuals investigated showed great losses in functional capacity in relation to their situation before hospitalization and half of them became dependent. 18 It was identified, in a study at the university hospital of Paraíba with the elderly, that increased functional capacity is correlated with increased resilience and, therefore, better coping with the disease. 25 Upon returning home from the hospital, young and long-lived elderly who were admitted to the ICU reported tiredness, exhaustion, pain, poor circulation in the legs after surgery, dyspnea, inappetence, gastric and intestinal problems such as constipation.…”