An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study

Abstract

IntroductionThe socio-economic impact of critical illnesses on patients and their families in Europe has yet to be determined. The aim of this exploratory study was to estimate changes in family circumstances, social and economic stability, care requirements and access to health services for patients during their first 12 months after ICU discharge.MethodsMulti-center questionnaire-based study of survivors of critical illness at 6 and 12 months after ICU discharge.ResultsData for 293 consenting patients who spent greater than 48 hours in one of 22 UK ICUs were obtained at 6 and 12 months post-ICU discharge. There was little evidence of a change in accommodation or relationship status between pre-admission and 12 months following discharge from an ICU. A negative impact on family income was reported by 33% of all patients at 6 months and 28% at 12 months. There was nearly a 50% reduction in the number of patients who reported employment as their sole source of income at 12 months (19% to 11%) compared with pre-admission. One quarter of patients reported themselves in need of care assistance at 6 months and 22% at 12 months. The majority of care was provided by family members (80% and 78%, respectively), for half of whom there was a negative impact on employment. Amongst all patients receiving care, 26% reported requiring greater than 50 hours a week. Following discharge, 79% of patients reported attending their primary care physician and 44% had seen a community nurse. Mobility problems nearly doubled between pre-admission and 6 months (32% to 64%). Furthermore, 73% reported moderate or severe pain at 12 months and 44% remained significantly anxious or depressed.ConclusionsSurvivors of critical illness in the UK face a negative impact on employment and commonly have a care requirement after discharge from hospital. This has a corresponding negative impact on family income. The majority of the care required is provided by family members. This effect was apparent by 6 months and had not materially improved by 12 months. This exploratory study has identified the potential for a significant socio-economic burden following critical illness.

The status of intensive care medicine research and a future agenda for very old patients in the ICU

“…For example, cognitive and functional impairment among survivors of severe sepsis had not improved after 1, 3 and 5 years in the study by Iwashyna et al [28]. In the study by Griffith et al [31], the physical component of SF36 was similar in patients below and above 64 years old, and it did not improve from 6 to 12 months after discharge. The mental score was better preserved in the patients over 64 years old but again did not improve over time.…”

Assessment of functional status in the ICU: instruments used in Brazilian settings

“…Its use may guide an early intensive recovery, contributing to achieving a better functional outcome in patients with traumatic brain injury in the irst months after injury, thus increasing their chance of returning to work (28). The results of the study revealed that a worse functional status, as assessed by the extended Glasgow individuals and families (8). In this context, although many different tools are already available for the diagnosis of physical functional status in intensive care units, there is an emerging need for transcultural development or adaptation studies, followed by a methodological validation process for use in Brazilian settings.…”

“…Within this context, a prolonged ICU stay negatively affects physical functioning because it leads to numerous consequences for the physical and psychological capacity of patients, in addition to the social and economic impacts to the individual and his/her family (8). This has a negative in luence on the patients' quality of life and can persist for years after discharge from the ICU (5,9,10).…”

Sindrom postintenzivne skrbi Post-intensive care syndrome

“…Rezultati provedenih istraživanja pokazuju da je 64% preživjelih u JIL-u imalo problema s pokretljivošću koje je trajalo šest mjeseci [2]. Nadalje, u 73% ispitanika verificira se postojanje boli srednjeg do teškog stupnja.…”

“…Međutim, budući da su simptomi dugotrajni, a stanje neprepoznato, teš-ko je odrediti vrijeme, nakon kritične bolesti, kada se PICS točno razvija. Tijekom godine dana u Sjedinjenim Američ-kim Državama, u JIL-u se liječi 5,7 milijuna bolesnika, a u oko 4,8 milijuna završetak liječenja je bez komplikacija [2]. Iako je nepoznata točna prevalencija među preživjelima, procjenjuje se da kod 25 do 50% bolesnika nastaje neka disfunkcija iz sklopa sindroma (kognitivne, psihičke ili fizičke) [3].…”