Abstract
Today, 10%-15% of Norwegian intensive care patients are ≥80years. This proportion will increase significantly over the next 20years, but it is unlikely that resources for intensive care increase correspondingly. Thus, it is important to establish which patients among elderly people will benefit from intensive care. The main objective of the study was to investigate the relationships between geriatric scoring tools and 30-day mortality. The study included 451 Norwegian patients ≥80years who were included in two prospective European observation studies (VIP (very old intensive care patient)1 of VIP2). Both studies included clinical frailty scale (CFS) while VIP2 also obtained the geriatric scores, comorbidity and polypharmacy score (CPS), Short Form of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and Katz Activity of Daily Living score (Katz ADL). Survival after 30days was 59.9%. Risk factors for 30-day mortality were increasing Sequential Organ Failure Assessment (SOFA) score (odds ratio (OR) 1.30; confidence interval (CI) 95% 1.22-1.39) and (CFS)>3 (CFS 4: OR 1.96 (CI 95% 1.01-3.81); CFS 5-9: OR 1.81 (CI) 95% 1.12-2.93)). Data from VIP2 showed that CFS was the only independent predictor of 30-day mortality when these scores were tested in multivariate analyses separately together with age, SOFA, and gender (OR 1.21 (95% CI 1.03-1.41)). Elderly intensive care patients had a 30-day survival rate of 59.9%. Factors strongly associated with 30-day mortality were increasing SOFA score and increasing frailty (CFS). Other geriatric scores had no significant association with survival in multivariate analyses.
Highlights
Introduction10%-15% of Norwegian intensive care patients are ≥80 years. This proportion will increase significantly over the 20 years, but it is unlikely that resources for intensive care increase correspondingly
Today, 10%-15% of Norwegian intensive care patients are ≥80 years
Based on a Norwegian cohort of intensive care patients aged 80 years or older at the time of intensive care unit (ICU) admission, we have studied the association among frailty, cognitive failure, comorbidity, the general health condition, and 30-day mortality
Summary
10%-15% of Norwegian intensive care patients are ≥80 years. This proportion will increase significantly over the 20 years, but it is unlikely that resources for intensive care increase correspondingly. Methods: The study included 451 Norwegian patients ≥80 years who were included in two prospective European observation studies (VIP (very old intensive care patient)[1] of VIP2) Both studies included clinical frailty scale (CFS) while VIP2 obtained the geriatric scores, comorbidity and polypharmacy score (CPS), Short Form of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and Katz Activity of Daily Living score (Katz ADL). Intensive care patients over 80 years of age have a reduced long- term prognosis with a 1-year survival of about 40%.6-10 elderly patients are in danger of being less prioritized in future intensive care medicine. Recent examples of such prioritization were seen in overfilled ICUs in countries like China, Italy, and Spain during the outbreak of COVID-19.
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