Do Intensive Care Unit treatment modalities predict mortality in geriatric patients: An observational study from an Indian Intensive Care Unit

Abstract

Background:Ageing being a global phenomenon, increasing number of elderly patients are admitted to Intensive Care Units (ICU). Hence, there is a need for continued research on outcomes of ICU treatment in the elderly.Objectives:Examine age-related difference in outcomes of geriatric ICU patients. Analyze ICU treatment modalities predicting mortality in patients >65 years of age.Materials and Methods:A retrospective observational study was conducted in 2317 patients admitted in a multi-specialty ICU of a tertiary care hospital over 2-year study period from January 1, 2011 to December 31, 2012. A clinical database was collected which included age, sex, specialty under which admitted, APACHE-II and SOFA scores, patient outcome, average length of ICU stay, and the treatment modalities used in ICU including mechanical ventilation, inotropes, hemodialysis, and tracheostomy. Patients were divided into two groups: <65 years (Control group) and >65 years (Geriatric age group).Results:The observed overall ICU mortality rate in the study population was 19.6%; no statistical difference was observed between the control and geriatric age group in overall mortality (P > 0.05). Mechanical ventilation (P = 0.003, odds ratio [OR] =0.573, 95% confidence interval [CI] =0.390–0.843) and use of inotropes (P = 0.018, OR = 0.661, 95% CI = 0.456–0.958) were found to be predictors of mortality in elderly population. On multivariate analysis, inotropic support was found to be an independent ICU treatment modality predicting mortality in the geriatric age group (β coefficient = 1.221, P = 0.000).Conclusion:Intensive Care Unit mortality rates increased in the geriatric population requiring mechanical ventilation and inotropes during ICU stay. Only inotropic support could be identified as independent risk factor for mortality.

Mortality in Critically Ill Elderly Individuals Receiving Mechanical Ventilation

“…All the studies included were cohort studies, 6 were retrospective, [16][17][18][19][20][21] and 5 were prospective. [22][23][24][25][26] Three stud-ies compared several groups according to age and, subsequently, to perform the meta-analysis, these groups were divided into 2 groups, with an age cutoff point of 65 y.…”

“…In 2 studies, the ages were between 45 and 64 y. 16,18 In another study, the ages were between 55 and 64 y; 23 and, in the rest of the studies, all the subjects were Ͻ64 y old. The characteristics of the studies included are summarized in Table 1.…”

“…As evaluated according to the checklist of Downs and Black, 9 10 studies averaged between 50 and 69% (a fair study quality) [16][17][18][19][20][21][22][23]25,26 ; one averaged between 70 and 79% (a good study quality). 24 All 11 studies reported on mortality, [16][17][18][19][20][21][22][23][24][25][26] 7 reported on hospital mortality, 17,20,21,[23][24][25][26] and 5 reported on ICU mortality. 16,18,19,22,24 We pooled all those studies and used a random-effects model because the I 2 value was 71%.…”

Diagnosis and Mortality Outcomes of Three Different Geriatric Age Groups in the Intensive Care Unit: 10-Year Retrospective Analysis

“…Our study determined the mortality rate in geriatric intensive care patients to be 40%. In a study that did not discriminate between adult and geriatric age, the mortality rate was observed to be 19.6% (13). Among the 5932 patients included in the study, the proportion of female geriatric patients was determined to be high with 3696 female patients (62%).…”

Relationship between age and intensive care unit-acquired bloodstream infections in infectious disease patients in Croatia

“…According to previous reports from different countries, the proportion of ICU-treated elderly patients ranges between 26-52% [1,2] and a shift in primary ICU diagnoses from cardiovascular to infectious diseases in elderly patients has been observed in a recent study [3]. In comparison with the younger population, community-acquired infections are more common and associated with a poorer outcome in elderly patients [4].…”