What is the importance of age on treatment of the elderly in the intensive care unit?

Abstract

By 2050, the percentage of the population older than 80 years will double, and some data suggest that elderly patients receive less advanced treatment. Information of outcome in elderly (≥ 65 year), representing roughly half the intensive care unit (ICU) admissions, in Sweden is scarce. Retrospective cohort study. We included all critically ill patients aged 65 or older (n = 605), admitted to the ICU during the years 2010-2011. Patients were categorized into two age groups: 65-79 (64%) and above 80 (36%). Demographic and epidemiology data were registered, as well as primary diagnosis, Simplified Acute Physiology Score III (SAPS III) mortality (ICU and hospital), withhold/withdraw life-sustaining treatment, the ICU workload, length of stay (ICU and hospital) and discharge location. Hospital mortality was significantly higher in patients above 80 years compared with patients 65-79 years of age (33.7% vs. 22.8%). These patients received less treatment and obtained more limitations in care (withhold/withdraw life-sustaining treatments). Patients above 80 years received less invasive ventilatory support (28.3% vs. 37.8%) and shorter length of invasive ventilatory support (1.1 ± 3.9 vs. 2.9 ± 7.4) compared with patients aged 65-79. In multivariate analysis, patients ≥ 80 years received less mechanical ventilation and more limitations in care even after adjustment for SAPS III and comorbidity. Patients above 80 years received less treatment and obtained more limitations in life-sustaining treatments compared with patients aged 65-79, even after adjustment for severity of illness and comorbidity.