Quality of life in patients aged 80 or over after ICU discharge

Abstract

IntroductionOur objective was to describe self-sufficiency and quality of life one year after intensive care unit (ICU) discharge of patients aged 80 years or over.MethodsWe performed a prospective observational study in a medical-surgical ICU in a tertiary non-university hospital. We included patients aged 80 or over at ICU admission in 2005 or 2006 and we recorded age, admission diagnosis, intensity of care, and severity of acute and chronic illnesses, as well as ICU, hospital, and one-year mortality rates. Self-sufficiency (Katz Index of Activities of Daily Living) was assessed at ICU admission and one year after ICU discharge. Quality of life (WHO-QOL OLD and WHO-QOL BREF) was assessed one year after ICU discharge.ResultsOf the 115 consecutive patients aged 80 or over (18.2% of admitted patients), 106 were included. Mean age was 84 ± 3 years (range, 80 to 92). Mortality was 40/106 (37%) at ICU discharge, 48/106 (45.2%) at hospital discharge, and 73/106 (68.9%) one year after ICU discharge. In the 23 patients evaluated after one year, self-sufficiency was unchanged compared to the pre-admission status. Quality of life evaluations after one year showed that physical health, sensory abilities, self-sufficiency, and social participation had slightly worse ratings than the other domains, whereas social relationships, environment, and fear of death and dying had the best ratings. Compared to an age- and sex-matched sample of the general population, our cohort had better ratings for psychological health, social relationships, and environment, less fear of death and dying, better expectations about past, present, and future activities and better intimacy (friendship and love).ConclusionsAmong patients aged 80 or over who were selected at ICU admission, 80% were self-sufficient for activities of daily living one year after ICU discharge, 31% were alive, with no change in self-sufficiency and with similar quality of life to that of the general population matched on age and sex. However, these results must be interpreted cautiously due to the small sample of survivors.

Assessing the utility of ICU admission for octogenarians

“…The unadjusted ICU mortality in our cohort (25 %) is comparable to other previously published figures [12,24,25], although significantly lower when compared with other reports addressing the outcome of critically ill elderly patients admitted to ICU [14,26,27]. However, this mortality rates comparison would require adjustment of confounding factors such as comorbidities and severity of illness.…”

Cardiovascular profile in critically ill elderly medical patients: Prevalence, mortality and length of stay

“…Prevalence of ICU mortality, in-hospital mortality and 1-year mortality was in agreement with previously published literature, where results vary between 19.5%-47% [22,[24][25][26], 33%-55% [3,22,27] and 48%-67% [24,28] respectively. The medians of ICU and hospital length of stay were in the range reported in other series [6,29,30].…”

Is this critically ill patient elderly or too old?

“…Estimation of the benefits of ICU admission should be considered not only in terms of survival but also taking into account the restoration of an acceptable quality of life [5]. Factors associated with prognosis in very old ICU patients have been studied but none of them had enough power to be recommended as strong indicators for the triage of these patients [4,[6][7][8].…”