Differences in early, intermediate, and long-term mortality among elderly patients admitted to the ICU: results of a retrospective observational study

POOLE, Daniele; Bianchin, Andrea; CARIA, Federico C.; CERO, Paolo DAL; CIAN, Sabrina DE; GALEOTTI, Elsa; MENATO, Lorenza; PETA, Mario; TURCHET, Federica; ZAMPERONI, Anna

doi:10.23736/s0375-9393.22.16002-5

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…Chronic conditions and impairments, which determine the health status in most very old patients, are established predictors of ICU survival [ 53 , 54 ]. They were shown to have an increasing statistical impact on in-hospital mortality the longer patients are in intensive care [ 55 ] and a profound influence on survival at 6 months in very old patients [ 29 ]. However, frequent geriatric conditions, such as neurocognitive disorders, are still not taken into account by the classical disease severity scores.…”

Section: Disease Severity Scoresmentioning

confidence: 99%

“…pubmed. gov) for articles with a special emphasis on this particular cohort using the query "(older[ti] OR "very old"[ti] OR "oldest old"[ti] OR elderly[ti]) AND patient* AND ("intensive care" OR "critical care") AND (outcome* OR survival OR mortality) AND (prognos* OR predict*) AND model*" identified five original studies published in the past 10 years [29][30][31][32][33], after the exclusion of studies using databases and those involving disease-specific subgroups or published by our own group.…”

Section: Predictive Modellingmentioning

confidence: 99%

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Prognosticating the outcome of intensive care in older patients—a narrative review

Beil,

Moreno,

Fronczek

et al. 2024

Ann. Intensive Care

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Prognosis determines major decisions regarding treatment for critically ill patients. Statistical models have been developed to predict the probability of survival and other outcomes of intensive care. Although they were trained on the characteristics of large patient cohorts, they often do not represent very old patients (age ≥ 80 years) appropriately. Moreover, the heterogeneity within this particular group impairs the utility of statistical predictions for informing decision-making in very old individuals. In addition to these methodological problems, the diversity of cultural attitudes, available resources as well as variations of legal and professional norms limit the generalisability of prediction models, especially in patients with complex multi-morbidity and pre-existing functional impairments. Thus, current approaches to prognosticating outcomes in very old patients are imperfect and can generate substantial uncertainty about optimal trajectories of critical care in the individual. This article presents the state of the art and new approaches to predicting outcomes of intensive care for these patients. Special emphasis has been given to the integration of predictions into the decision-making for individual patients. This requires quantification of prognostic uncertainty and a careful alignment of decisions with the preferences of patients, who might prioritise functional outcomes over survival. Since the performance of outcome predictions for the individual patient may improve over time, time-limited trials in intensive care may be an appropriate way to increase the confidence in decisions about life-sustaining treatment.

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