Is age a predictor of mortality in a UK medical high dependency unit?

Abstract

The population aged older than 65 yr is set to increase by 32% by 2033. In resource-limited environments, difficult decisions regarding access to high dependency care for the elderly are increasingly important. The aim of this study was to determine whether age is a predictor of mortality in patients admitted to an open medical high dependency unit (MHDU). Prospective observational cohort study of 100 consecutive patients admitted to an MHDU with a primary medical diagnosis over a 3 month period. The primary endpoint was 30 day mortality. Overall mortality at 30 days was 21% (n=21). Patients aged <65 yr were 41%, 29% were 65-74 yr, and 30% were aged 75 yr and above. There were no significant differences in mortality between groups (12%, 31%, and 23%, respectively). When considering Acute Physiology and Chronic Health Evaluation scores ≥25, there was no significant difference in mortality between age groups [35% <70 yr (7/20) vs. 29% ≥70 yr (4/14), P=1.000]. The final model at multivariable regression analysis identified that ≥2 organ support (odds ratio 10.84, 95% confidence interval 3.28-35.84) and pre-admission moderate/nursing home care [4.44 (1.05-18.70)] were significantly associated with worse outcome. The majority of survivors (88%) were discharged at their pre-admission functional status; those who declined in function were not significantly older than those who did not. Age does not predict the outcome from an MHDU. Those requiring ≥2 organ support, higher levels of pre-admission home support, or both had higher mortality. Selected elderly medical patients should not be denied high dependency unit care.