[en] OBJECTIVE: To examine the outcome, functional autonomy, and quality of life of elderly patients (> or = 70 yrs old) hospitalized for >30 days in an intensive care unit (ICU). DESIGN: Prospective cohort study. SETTING: A ten-bed, medical-surgical ICU in a 460-bed, acute care, tertiary, university hospital. PATIENTS: A consecutive cohort of 75 patients, >70 yrs old, admitted to the ICU from January 1, 1993, to August 1, 1998, for >30 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Severity at admission and of the underlying disease was estimated according to the Simplified Acute Physiologic Score (SAPS II), the Organ Dysfunction and/or Infection (ODIN) score, the McCabe score, and the Knaus classification. Therapeutic intensity was measured through the French Omega scoring system. All patients were mechanically ventilated during their ICU stay. Outcome measurements were made by two cross-sectional studies using telephone interviews on the first week of September 1996 and 1998 with a questionnaire including measures of functional capacity by Katz's Activities of Daily Living, modified Patrick's Perceived Quality of Life score, and the Nottingham Health Profile. The survival rate was 67% in the ICU and 47% in the hospital. A total of 30 patients were alive and able to participate in at least one of the cross-sectional studies. Independence in activities of daily living was decreased significantly after the ICU stay, except for feeding. However, most of the 30 patients remained independent (class A of the Activities of Daily Living index) with the possibility of going home. Perceived Quality of Life scores remained good, even if the patients estimated a decrease in their quality of life for health and memory. Return to society appeared promising regarding patient self respect and happiness with life. The estimated cost by survivor was of 55,272 EUR ($60,246 US). CONCLUSIONS: This study suggests that persistent high levels of ICU therapeutic intensity were associated with a reasonable hospital survival in elderly patients experiencing prolonged mechanical ventilatory support. These patients presented a moderate disability that influenced somewhat their perceived quality of life. These results are sufficient to justify prolonged ICU stays for elderly patients.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Montuclard, Luc
Garrouste-Orgeas, Maïté
Timsit, Jean-François
Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > Service de Soins Intensifs
De Jonghe, Bernard
Carlet, Jean
Language :
English
Title :
Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay.
Publication date :
2000
Journal title :
Critical Care Medicine
ISSN :
0090-3493
eISSN :
1530-0293
Publisher :
Lippincott Williams & Wilkins, United States - Pennsylvania
Jakob S.M., Rothen H.U. (1997) Intensive care 1980-1995: Change in patients characteristics, nursing workload and outcome. Intensive Care Med 23:1165-1170.
Groeger J.S., Kalpalatha K., Guntupalli (1993) Descriptive analysis of critical care units in the United States: Patient characteristics and intensive care unit utilization. Crit Care Med 21:279-291.
Campion E.W., Mulley A.G., Goldstein R.L. (1981) Medical intensive care for the elderly. A study of current use, costs and outcome. JAMA 246:2052-2056.
Thibault G.E., Mulley A.G., Barnett G.O. (1980) Medical intensive care: Indications, interventions, and outcomes. N Engl J Med 302:938-942.
Nicolas F., Le Gall J.R., Alperovitch A. (1987) Influence of patients' age on survival, level of therapy and length of stay in intensive care units. Intensive Care Med 13:9-13.
Rockwood K., Noseworthy T.W., Noel Gibney R.T. (1993) One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med 21:687-691.
Le Gall J.R., Brun-Buisson C., Trunet P. (1982) Influence of age, previous health status and severity of acute illness on outcome from intensive care. Crit Care Med 10:575-577.
Kass J.E., Castriotta R.J., Malakoff F. (1992) Intensive care unit outcome in the very elderly. Crit Care Med 20:1666-1671.
McLean R.F., McIntosh J.D., Kung G.Y. (1985) Outcome of respiratory intensive care for the elderly. Crit Care Med 13:625-629.
Mahul P., Perrot D., Tempelhoff G. (1991) Short- and long-term prognosis, functional outcome following ICU for elderly. Intensive Care Med 17:7-10.
Le Gall J.R., Lemeshow S., Saulnier F. (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957-2963.
McCabe W.R., Jackson G.G. (1962) Gram negative bacteremia: Etiology and ecology. Arch Intern Med 110:847-855.
Knaus W.A., Drapper E.A., Wagner D.P. (1985) APACHE II: A severity of disease classification system. Crit Care Med 13:818-829.
Fagon J.Y., Chastre J., Novara A. (1993) Characterization of intensive care units patients using a model based on the presence or absence of organ dysfunction and/or infection: The ODIN model. Intensive Care Med 19:137-144.
(1986) Utilisation de l'indice de gravite simplifee et du systeme omega: Mise a jour 1986. Reanimation Soins Intensifs Medecine Urgences 2:219-221.
Sznajder M., Leleu G., Buonamico G. (1998) Estimation of direct cost and resource utilization allocation in intensive care: Correlation with Omega system. Intensive Care Med 24:582-589.
Ridley S.A., Wallace P.G.M. (1990) Quality of life after intensive care. Anaesthesia 45:808-813.
Katz S. (1983) Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721-727.
Patrick D.L., Danis M., Southerland L.I. (1988) Quality of life following intensive care. J Gen Intern Med 3:218-223.
Hunt S.M., McKenna S.P., McEwen S.P. (1980) A quantitative approach to perceive health status. J Epidemiol Community Health 34:261-286.
Bucquet D., Condon S., Ritchie K. (1990) The French version of the Nottingham health profile: A comparison of items weights with those of the source version. Soc Sci Med 30:829-837.
Hurel D., Loirat P., Saulner F. (1997) Quality of life six months after intensive care: Results of a prospective multicenter study using a generic health status scale and a satisfaction scale. Intensive Care Med 23:331-337.
Tian M., Miranda R. (1995) Quality of life after intensive care with the sickness impact profile. Intensive Care Med 21:422-428.
Heyland D.K., Konopad E., Noseworthy T.W. (1998) Is it worthwhile to continue treating patients with a prolonged stay (>14 days) in the ICU? An economic evaluation. Chest 114:192-198.
Spicher J.E., White D.P. (1987) Outcome and function following prolonged mechanical ventilation. Arch Intern Med 147:421-425.
Cohen I.L., Lambrinos J., Fein A. (1993) Mechanical ventilation for the elderly patient in intensive care: Incremental charges and benefits. JAMA 269:1025-1029.
Gracey D.G., Naessens J.M., Viggiano R.W. (1995) Outcome of patients cared for in a ventilator-dependent unit in a general hospital. Chest 107:494-499.
Ely E.W., Evans G.W., Haponik E.F. (1999) Mechanical ventilation in a cohort of elderly patients admitted to an intensive care. Ann Intern Med 131:96-104.
Sage W.M., Hurst C.R., Silverman J.F. (1987) Intensive care of elderly: Outcome of elective and non-elective admission. J Am Geriatr Soc 35:312-318.
Roche V.M., Kramer A., Hester E. (1999) Longterm functional outcome after intensive care. J Am Geriatr Soc 47:18-24.
Grimby A., Wiklund I. (1994) Health-related quality of life in old age. A study among 76-year-old Swedish urban citizens. Scand J Soc Med 22(1):7-14.
Kerjosse R., Tamby I. (1999) La situation demographique en 1996: Mouvement de la population. Institut national de la statistique et des etudes economiques (INSEE). Demographie Societe 70-71:134.
