The Baby Boom and later life: is critical care fit for the future?

Pugh, Richard; Thorpe, Chris; Szakmány, Tamás

doi:10.5603/ait.a2017.0078

Cited by 2 publications

(1 citation statement)

References 28 publications

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“…Demand for critical care services is rising in many countries due to population ageing (1), advances in medical care and changes in patient, public and clinical expectations (2, 3). However, as healthcare becomes more expensive, there is heightened interest in the appropriate use of expensive care modalities, particularly where financial austerity is felt (4).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Szakmány

Walters

Pugh

et al. 2019

Critical Care Medicine

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Objective Clear understanding of the long-term consequences of critical care survivorship is essential. We investigated the care process and individual factors associated with long-term mortality among ICU survivors and explored hospital use in this group. Design Population based data linkage study using the Secure Anonymised Information Linkage (SAIL) databank. Setting All ICUs between 2006-2013 in Wales, UK. Patients We identified 40,631 patients discharged alive from Welsh adult ICUs. Intervention none. Measurements and Main results Primary outcome was 365-day survival. The secondary outcomes were 30 and 90-day survival and hospital utilisation in the 365 days following ICU discharge. Kaplan-Meier curves were plotted to compare survival rates. Cox proportional hazards regression models were used to determine risk factors of mortality. 7,883 (19.4%) patients died during the 1-year follow-up period. In the multivariable Cox regression analysis, advanced age and comorbidities were significant determinants of long-term mortality. Expedited discharge due to ICU bed shortage was associated with higher risk. The rate of hospitalisation in the year prior to the critical care admission was 28 hospitalised days/1000 days, post critical care was 88 hospitalised days/1000 days for those who were still alive; and 57 hospitalised days/1000 days and 412 hospitalised days/1000 days for those who died by the end of the study, respectively. Conclusions One in five ICU survivors die within one year, with advanced age and comorbidity being significant predictors of outcome, leading to high resource use. Care process factors indicating high system stress were associated with increased risk. More detailed understanding is needed on the effects of the potentially modifiable factors to optimise service delivery and improve long-term outcomes of the critically ill.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Szakmány

Walters

Pugh

et al. 2019

Critical Care Medicine

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Meeting complex multidimensional needs in older patients and their families during and beyond critical illness

Santangelo,

Wozniak,

Herridge

2024

Current Opinion in Critical Care

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Purpose of review To highlight the emerging crisis of critically ill elderly patients and review the unique burden of multidimensional morbidity faced by these patients and caregivers and potential interventions. Recent findings Physical, psychological, and cognitive sequelae after critical illness are frequent, durable, and robust across the international ICU outcome literature. Elderly patients are more vulnerable to the multisystem sequelae of critical illness and its treatment and the resultant multidimensional morbidity may be profound, chronic, and significantly affect functional independence, transition to the community, and quality of life for patients and families. Recent data reinforce the importance of baseline functional status, health trajectory, and chronic illness as key determinants of long-term functional disability after ICU. These risks are even more pronounced in older patients. Summary The current article is an overview of the outcomes of older survivors of critical illness, putative interventions to mitigate the long-term morbidity of patients, and the consequences for families and caregivers. A multimodal longitudinal approach designed to follow patients for one or more years may foster a better understanding of multidimensional morbidity faced by vulnerable older patients and families and provides a detailed understanding of recovery trajectories in this unique population to optimize outcome, goals of care directives, and ongoing informed consent to ICU treatment.

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The Baby Boom and later life: is critical care fit for the future?

Cited by 2 publications

References 28 publications

Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Meeting complex multidimensional needs in older patients and their families during and beyond critical illness

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