Abstract
BackgroundThere is an increase in admission rate for elderly patients to the ICU. Mortality rates are lower when more liberal ICU admission threshold are compared to more restrictive threshold. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital before and after the addition of an 8-bed medical ICU.MethodsWe conducted a retrospective analysis of a comprehensive longitudinal ICU database, from a large tertiary medical center, examining trends in patients’ characteristics, severity of illness, intensity of care and mortality rates over the years 2001–2008. The study population consisted of elderly patients and the primary endpoints were 28 day and one year mortality from ICU admission.ResultsBetween the years 2001 and 2008, 7,265 elderly patients had 8,916 admissions to ICU. The rate of admission to the ICU increased by 5.6% per year. After an eight bed MICU was added, the severity of disease on ICU admission dropped significantly and crude mortality rates decreased thereafter. Adjusting for severity of disease on presentation, there was a decreased mortality at 28- days but no improvement in one- year survival rates for elderly patient admitted to the ICU over the years of observation. Hospital mortality rates have been unchanged from 2001 through 2008.ConclusionIn a high capacity ICU bed hospital, there was a temporal decrease in severity of disease on ICU admission, more so after the addition of additional medical ICU beds. While crude mortality rates decreased over the study period, adjusted one-year survival in ICU survivors did not change with the addition of ICU beds. These findings suggest that outcome in critically ill elderly patients may not be influenced by ICU admission. Adding additional ICU beds to deal with the increasing age of the population may therefore not be effective.
Highlights
The raison d’etre of intensive care units is to improve clinical outcomes for acutely ill patients
Across the four time periods of the study there was an annual increase in elderly ICU admission of 5.6% per year
The most prevalent etiology for ICU admission was cardiovascular, the rate dropped from 25.6% of all ICU admissions on first study time period to 19.4% during the final time period (Table 1)
Summary
The raison d’etre of intensive care units is to improve clinical outcomes for acutely ill patients. Reaching a balance between judicious utilization of a limited and high cost resource and providing optimal intensity of care is challenging This is the case in relation to elderly patients. While ICU admission can change clinical outcomes for many elderly patients, for others the value of ICU care is questionable [6]. A previous European based study found that higher ICU acceptance rate improved survival rates for very elderly patients, especially among those who were previously considered ‘‘not sick enough’’ for ICU admission [7]. This finding highlights the impact of ICU bed capacity and triage on ICU survival. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital before and after the addition of an 8-bed medical ICU
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