Effect of Type of Admission on Short‐ and Long‐term Outcome of Nonagenarians Admitted to an Intensive Care Unit

Japiassú, André Miguel; Oliveira, Bruno Assis de; Gondim, Carlos Roberto Naegeli; Kurtz, Pedro; Almeida, G. F. de; Pinto, Márcia; Martins, Leonam C.; Kalichsztein, Marcelo; Nobre, Gustavo Freitas

doi:10.1111/j.1532-5415.2009.02297.x

Cited by 2 publications

(4 citation statements)

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“…Few studies reported the percentage of nonagenarians in ICU admissions. In our study, nonagenarians represented around 8 % of ICU admissions, higher than the rates observed in a Brazilian [ 13 ], Norway [ 26 ], or French study [ 6 ] 3, 2.5, or 1 %, respectively. The percentage of patients aged 85 years and over represented only 3.4 % in the Eldicus study [ 25 ].…”

Section: Discussioncontrasting

confidence: 70%

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Treatment intensity and outcome of nonagenarians selected for admission in ICUs: a multicenter study of the Outcomerea Research Group

Garrouste-Orgeas

Ruckly²,

Grégoire

et al. 2016

Ann. Intensive Care

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BackgroundOutcome of very elderly patients admitted in intensive care unit (ICU) was most often reported for octogenarians. ICU admission demands for nonagenarians are increasing. The primary objective was to compare outcome and intensity of treatment of octogenarians and nonagenarians.MethodsWe performed an observational study in 12 ICUs of the Outcomerea™ network which prospectively upload data into the Outcomerea™ database. Patients >90 years old (case patients) were matched with patients 80–90 years old (control patients). Matching criteria were severity of illness at admission, center, and year of admission.ResultsA total of 2419 patients aged 80 or older and admitted from September 1997 to September 2013 were included. Among them, 179 (7.9 %) were >90 years old. Matching was performed for 176 nonagenarian patients. Compared with control patients, case patients were more often hospitalized for unscheduled surgery [54 (30.7 %) vs. 42 (23.9 %), p < 0.01] and had less often arterial monitoring for blood pressure [37 (21 %) vs. 53 (30.1 %), p = 0.04] and renal replacement therapy [5 (2.8 %) vs. 14 (8 %), p = 0.05] than control patients. ICU [44 (25 %) vs. 36 (20.5 %), p = 0.28] or hospital mortality [70 (39.8 %) vs. 64 (36.4 %), p = 0.46] and limitation of life-sustaining therapies were not significantly different in case versus control patients, respectively. Only 16/176 (14 %) of case patients were transferred to a geriatric unit.ConclusionThis multicenter study reported that nonagenarians represented a small fraction of ICU patients. When admitted, these highly selected patients received similar life-sustaining treatments, except RRT, than octogenarians. ICU and hospital mortality were similar between the two groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0133-9) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 70%

“…In a Brazilian study of nonagenarians admitted in a single center, the ICU and 6-month mortality for medical patients were 38 and 47 %, respectively. Of note, 25 % of patients were mechanically ventilated [ 13 ]. In a Greek single study, nonagenarians represented 1.1 % of the admitted population.…”

Section: Introductionmentioning

confidence: 99%

Treatment intensity and outcome of nonagenarians selected for admission in ICUs: a multicenter study of the Outcomerea Research Group

Garrouste-Orgeas

Ruckly²,

Grégoire

et al. 2016

Ann. Intensive Care

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“…Mortality in this subgroup was 56.7%. Compared with the younger population, they had lower BMI (25.4 [21.7-28.7] vs 26.7 [23.1-30.4], P = 0.025), higher SAPS 3 score (70.4 ± 12.9 vs 66.2 ± 14.1, P = 0.004), and higher Charlson Comorbidity Index score (6 [5-8] vs 6 [4][5][6][7], P < 0.001). There was no difference in energy and protein prescription between groups or in total fasting days.…”

Section: Age >80 Years and Exclusive Palliative Carementioning

confidence: 99%

“…The prevalence of sarcopenia is high in the older population (≥65 years of age), 3 and this characteristic may be accentuated during hospitalization, leading to the occupation of an essential portion of beds in intensive care unit (ICU). The presence of sarcopenia and frailty is an additional element of interest to the intensivist 4 because the combination of sarcopenia and critical illness is related to a worse prognosis 5–7 . Older patients may be inadvertently subjected to periods of inadequate protein intake, which can have a devastating effect 2 .…”

Section: Introductionmentioning

confidence: 99%

Nutrition as a risk for mortality and functionality in critically ill older adults

Loss

Teichmann

Paula

et al. 2022

J Parenter Enteral Nutr

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Background There is no specific recommendation for nutrition therapy for critically ill older adults. However, targeting energy and protein balance and avoiding fasting could improve outcomes in this population with high‐risk nutrition outcomes. This study aimed to evaluate the associations between nutrition and mortality/functionality in critically ill older patients. Methods A single‐center retrospective observational study of critically ill patients aged 65 years or older was conducted. We extracted data from the dietitian evaluations on energy, protein, and the type of diet (fasting, oral, enteral, or parenteral) prescribed in the first week of intensive care unit admission. Primary outcomes were intrahospital mortality and independence and functional capacity evaluated after hospital discharge. Results Of the 2043 patients screened, 533 were included in the study. Most patients were men (52.1%), with a median age of 73 (68–78) years. Overall, the intrahospital mortality rate was 53.8%. Simplified Acute Physiology Score 3 (SAPS 3), serum albumin and C‐reactive protein levels, and surgical patients were independently associated with fasting in a multivariate analysis. The multivariate regression analyses showed that SAPS 3, serum albumin level, and fasting were independently associated with mortality. Each fasting day increases the risk of mortality by 16.7%. Also, independence and functional capacity were not related to nutrition prescription. Conclusion Older adults (65 years or older) constitute a fragile population in whom nutrition breaks were associated with increased hospital mortality. Furthermore, a prospective clinical trial is necessary to establish the best strategy to feed this population.

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Effect of Type of Admission on Short‐ and Long‐term Outcome of Nonagenarians Admitted to an Intensive Care Unit

Cited by 2 publications

References 8 publications

Treatment intensity and outcome of nonagenarians selected for admission in ICUs: a multicenter study of the Outcomerea Research Group

Treatment intensity and outcome of nonagenarians selected for admission in ICUs: a multicenter study of the Outcomerea Research Group

Nutrition as a risk for mortality and functionality in critically ill older adults

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