Clinical Profile and Factors Affecting Outcomes in Elderly Patients Admitted to the Medical Intensive Care Unit of a Tertiary Care Hospital

Abstract

BackgroundIn recent years, there is an increase in the proportion of the elderly population in the world. With an increase in patients' age, there is a change in the comorbidities and causes for Intensive care unit (ICU) admissions. More studies are needed to redefine healthcare delivery to elderly patients admitted to ICU. AimsThe aims are to assess the disease pattern and outcome in elderly patients admitted to the Medical ICU and to determine factors affecting the outcomes in elderly patients admitted to the Medical ICU. MethodsThis was a retrospective cross-sectional study conducted in the Medical ICU of a tertiary care hospital for six months. Patients who met inclusion and exclusion criteria were included in this study. Data collected from medical records were statistically analysed. ResultsOut of 859 newly admitted patients to the Medical ICU, 196 (22.81%) were elderly patients (age > 60 years). The mean age of elderly patients was 69.8 ± 7.65 years. The mortality rate in elderly patients aged > 60 years was 36.70%, which was higher when compared to 23.60% in patients aged ≤ 60 years, and the correlation was statistically significant (p<0.0001). Neurological disorders (42.8%) were the most common cause of admissions, followed by renal disorders (13.26%), respiratory diseases (9.7%), and infections (9.18%). Deaths due to neurological disorders were most common (43.66%) followed by renal disorders (14.08%), infections (11.26%), and respiratory diseases (7%). The mean number of comorbidities in elderly patients was 1.99 ± 1.21. The mortality rate in elderly patients with more than three comorbidities was 56.52%, which was higher when compared to 33.52% in elderly patients with comorbidities ≤3, and the correlation was statistically insignificant (p=0.1275). The mean length of ICU stay in elderly patients was 9.14 ± 6.73 days. The length of stay in ICU was prolonged in patients with more number of comorbidities, which was statistically significant (p<0.0001). The mortality rate was higher in patients with prolonged length of stay, and the correlation was statistically significant (p=0.0013). ConclusionThe insight over the proportion of older patients admitted to the ICU will enable policy-makers to plan accordingly. Mortality in elderly patients was high. Hence there is a need to redefine healthcare delivery to elderly patients in terms of triage and level of care in ICU. For better outcomes, risk categorisation can be done based on the number of comorbidities for optimal care. Exclusive geriatric intensive care units were needed for better care of elderly patients.

Characteristics and Outcome of Elderly Admitted to the Intensive Care Unit in Bahrain

“…Similar findings were reported in a study conducted by Ball et al, greater mortality rates in patients with prolonged ICU stay may be either because of severe illness or ICU-related complications like ventilator-associated pneumonia, central venous catheterassociated infection, urinary catheter-associated infection, venous thromboembolism and stress ulcers [11,21,25].…”

“…The mortality rate over two years was 28.8% (n=59); males accounted for 47.5% (n=28), and females accounted for 52.5% (n=31), which was lessened when compared to 36.7% in a study conducted by Upparakadiyala et al and published in 2022 [11]. However, in a study conducted by Thangam & Deepa, the mortality rate was 25%, which could be attributed to admission diagnosis as acute cardiac and COVID-19 infection cases were admitted to dedicated intensive care units.…”

“…Nonetheless, it is yet to be determined whether elderly mortality in ICU is independently determined by age or other factors. Elderly patients frequently suffer from multiple comorbidities before admission and meet the physiological demands of critical illness [9][10][11].…”

A comparison of clinical profile and outcomes among different age groups of critically ill elderly patients in a tertiary level hospital in Nepal: A retrospective study

“…This may be due to the tendency of extubating the post-operative elderly patients in the ICU. On evaluating the mortality rate, the mortality rate among elderly in our ICU was 35.2% which was lower than in the study of elderly done by Upparakadiyala et al,11 in Tirupati, India, but higher than Thangam and Deepa 5 in Chennai and Oh et al, 6 in South Korea. This shows that the care of our elderly is comparable to other developing nations.…”

A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Center

“…The duration of ICU stay in this study was higher than in earlier reported studies. 3 , 4 , 8 , 12 Probably this variation in the length of ICU stay may be due to differences in the severity of disease patterns, infections, and other complications. 12 In this study, the association between APACHE II scores of the patients and the duration of ICU stay was insignificant, as observed in previous studies.…”