Abstract
BackgroundAge alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU).MethodsA monocentric, retrospective, observational study of all patients aged ≥75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables.ResultsA total of 345 patients were included (56% female, mean age 85 +/− 6.5 years). Mean FIM score was 66 +/− 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68 and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores.ConclusionsIn the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.
Highlights
Age alone is not a robust predictor of mortality in critically ill elderly patients
Low Functional Independence Measure (FIM) scores were associated with an higher one-year mortality compared with high FIM score (68% vs 44% mortality, p < 0.0001)
mini-mental state (MMS), urea, albumin, and age appeared to be correlated with one-year mortality (p < 0.05) (Table 2)
Summary
Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. Several studies have suggested that age alone is not a strong predictor of mortality [5,6,7] This population’s health status is often difficult to assess because of multiple morbidities and frailty. Disease severity scores are well-known tools for evaluating risk of death in the short term. They help clinicians decide whether to admit a patient to an ICU or IMCU, even though their accuracy for very elderly patients is uncertain. Flatten et al reported that Clinical Frailty Scale scores were inversely associated with the short-term survival of very elderly patients (≥ 80 years) admitted to an ICU [9]. A frailty assessment before admission to an ICU or IMCU may provide more accurate prognostic information than age and comorbidities alone
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
