Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study

Abstract

BackgroundThe purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors.MethodsWe conducted a prospective observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period, except those admitted after cardiac arrest, All patients were followed for 3 months or until death. Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the Katz index of Activity of Daily Living (ADL). Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham Health Profile (NHP) score.ResultsOne hundred patients were included in the analysis. The mean age was 79.3 ± 3.4 years. The median Charlson index was 6 [IQR, 4 to 7] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4, respectively, corresponding to a population with a high level of comorbidities but low physical and cognitive dependence. Mortality was 61/100 (61%) at 3 months. In multivariate analysis only comorbidities assessed by the Charlson index [Adjusted Odds Ratio, 1.6; 95% CI, 1.2-2.2; p < 0.003] and the number of organ failures assessed by the SOFA score [Adjusted Odds Ratio, 2.5; 95% CI, 1.1-5.2; p < 0.02] were independently associated with 3-month mortality. All 22 patients needing renal support after Day 3 died. Compared with pre-admission, physical (p = 0.04), and cognitive (p = 0.62) dependence in survivors had changed very little at 3 months. In addition, the mean NHP score was 213.1 ± 132.8 at 3 months, suggesting an acceptable perception of their quality of life.ConclusionsIn a selected population of non surgical patients 75 years and older, admission into the ICU is associated with a 3-month survival rate of 38% with little impact on physical and cognitive dependence and subjective health status. Nevertheless, a high comorbidity level (ie, Charlson index), multi-organ failure, and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death.

Lower mortality rate in people with dementia is associated with better cognitive and functional performance in an outpatient cohort

“…In this preliminary study, cognitive impairment and especially ADL impairment were positively correlated with the death risk. This is in accordance to several prospective studies which have confirmed that low educated patients who live alone or in long term institutions are most prone to have cognitive and ADL impairment leading to impending death 21 . Furthermore, patients with clinical diseases such as diabetes or hypertension tend to have more cognitive impairment than those without any disease, and also they have higher mortality rates [22][23][24][25] .…”

Impact of Prompt Influenza Antiviral Treatment on Extended Care Needs After Influenza Hospitalization Among Community-Dwelling Older Adults

“…Jeitziner et al [20] reported that among older adults surviving ICU admission, a decline in physical functional status (measured by ADLs) was observed, and patients were likely to require assistance in perform such tasks as using public transportation, shopping, and doing laundry. Moreover, ICU survivors have documented worsening cognitive functions which could also explain the need for extended care at hospital discharge [21].…”

Understanding and Reducing Disability in Older Adults Following Critical Illness*

“…We also reviewed the bibliographies of relevant citations to identify additional citations. Overall, 19 studies met these criteria (2, 3, 29–45): 17 studies reported disability outcomes (2, 29–38, 40–42, 44), 2 studies reported cognitive outcomes (3, 45) and 2 studies reported both (39, 43). …”

“…New or worsened IADL disability was also common and reported in 22% to 45% of patients evaluated 3 months to almost 2 years following the index illness (34, 38, 43). A single study where a number of patients were disabled in ADLs and IADLs at baseline (43% and 60%, respectively) reported no change in disability at 3-month follow-up (42). Finally, disability in mobility activities was present in 14% to 87% of patients assessed during the first year following their index illness.…”