Abstract
BackgroundIntensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the 2 years after discharge in mortality, healthcare utilisation and frailty score between elderly survivors of ARI in the ICU and an elderly control population.MethodsWe used 2009–2017 data from 39 hospital discharge databases. Patients ≥ 80 years old discharged alive from ICU hospitalisation for acute respiratory infection were propensity score-matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilisation and frailty scores in the 2-year periods before and after ICU hospitalisation.ResultsOne thousand two hundred and twenty elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95% CI, 6.1–17.3] higher risk of death at 6 months and 3.6-fold [95% CI, 2.9–4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilisation and frailty score in the 2 years after hospital discharge, whereas healthcare utilisation and frailty scores among controls were stable before and after hospitalisation.ConclusionsWe observed a substantially increased rate of death in the years following ICU hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.
Highlights
The ageing of the population is a global trend of critical importance, with the number of individuals aged 80 years or older increasing the most rapidly (3.8% increase/year) [1]
Conflicting results are present in the literature: some studies report that advanced age is itself a risk factor for Intensive care unit (ICU) mortality and poor long-term quality of life due to persistent functional impairments [5,6,7,8], while other studies argue that chronological age alone should not be considered the sole criterion to preclude ICU admission [9, 10]
We previously demonstrated a substantial increase in hospitalisations for acute respiratory infection (ARI) over 10 years (2006–2015), with a change in the ICU admission policy for elderly patients leading to an important rise in ICU resource utilisation [11]
Summary
The ageing of the population is a global trend of critical importance, with the number of individuals aged 80 years or older increasing the most rapidly (3.8% increase/year) [1] This worldwide ageing has major consequences on health systems including increasing elderly patient admissions in hospitals and intensive care units (ICUs) [2, 3]. We previously demonstrated a substantial increase in hospitalisations for acute respiratory infection (ARI) over 10 years (2006–2015), with a change in the ICU admission policy for elderly patients leading to an important rise in ICU resource utilisation [11]. Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the 2 years after discharge in mortality, healthcare utilisation and frailty score between elderly survivors of ARI in the ICU and an elderly control population
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