Elderly Intensive Care Unit Patients Research Articles

Diagnosis and Risk Factors for Delirium in Elderly Patients in the Emergency Rooms and Intensive Care Unit of the National Geriatric Hospital Emergency Department: A Cross-Sectional Observational Study.

PurposeTo diagnose delirium and identify risk factors for its development in elderly patients in the emergency department (ED) and intensive care units (ICU) at the National Geriatric Hospital (Vietnam).Patients and MethodsA cross-sectional observational study was conducted with a convenience sample of non-surgical patients admitted to ED and ICU at Hanoi National Geriatric Hospital in Vietnam. In total, 163 patients met the selection criteria and were included in the study. Screening involved using the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The diagnosis was established according to the DSM-5 and ICD-10 codes.ResultsDelirium was found in a total of 106 (63.1%) patients. The factors significantly affecting its development were vision impairment (OR, 3.3; 95% CI, 1.5 to 7.4, P=0.003), hearing impairment (OR, 3.6; 95% CI, 1.77 to 7.36, P=0.0001), acute or chronic kidney failure (OR, 7.1; 95% CI, 2.05 to 6.39, P<0.001), respiratory disorders (OR, 2.7; 95% CI, 1.4 to 5.2, P=0.004), and malnutrition (OR, 9.17; 95% CI, 3.43–24.5, P=0.0001). The list also include the fall risk factors (OR, 12.2; 95% CI, 4.1–36.3, P=0.0001), frailty (OR, 8.35; 95% CI, 3.4–20.6, P=0.0001), activities of daily living (OR, 8.35; 95% CI, 3.4–20.6, P=0.0001), hyponatremia (OR, 2.48; 95% CI, 1.07 to 5.75, P=0.001), hypernatremia (OR, 13.1; 95% CI, 1.67 to 2.5, P=0.001), and treatment interventions. In addition, delirium was linked to the duration of ICU admission (OR, 6.53; 95% CI, 4.5–25.5, P < 0.0001).ConclusionThe CAM/CAM-ICU diagnostic algorithm makes it possible to diagnose delirium successfully. The present study confirmed the role of several premorbid and triggering factors in the occurrence of delirium in elderly patients in ED and ICU. There is a need for further research into risk factors for delirium in elderly patients.

Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

BackgroundThe primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.MethodsThis was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).ResultsIn total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%).ConclusionAn unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.Trial registration numberNCT04321265, registered March 19th, 2020.

Pre-albumin is a strong prognostic marker in elderly intensive care unit patients

Abstract Objectives Pre-albumin (PAB) can be used to evaluate the association between nutrition status and in-hospital mortality. However, there is no literature to compare if PAB is the best indicator to predict in-hospital mortality among the nutrition indexes in a study. Methods We operated a retrospective study including 145 patients admitted to our institution’s elderly intensive care unit (ICU) from January, 2017 to December, 2019. Admission laboratory results were collected. Regression analysis and receiver operating curve (ROC) were analyzed to explore the performance of different nutrition indexes. Results The levels of PAB were significantly different between the survivor and non-survivor group (p=0.001). Univariate analysis showed nutrition indexes (lymphocytes, albumin, body mass index [BMI], geriatric nutritional risk index (GNRI), prognostic nutritional index [PNI] and PAB) were associated with in-hospital mortality (all p&lt;0.1). Following adjustment for age, platelets and creatinine (CREA), only BMI and PAB remained statistically significant (BMI: HR 2.799, 95% CI 1.167–6.715, p=0.021; PAB: HR 6.329, 95% CI 2.660–15.151, p&lt;0.001). In addition, PAB had the highest area under the curve (AUC) for predicting in-hospital mortality (AUC = 0.696) followed by BMI (AUC = 0.561) and other factors. Conclusions PAB is a better predictor of in-hospital mortality than other nutrition indexes in elderly ICU patients.

The impact of transthoracic echocardiography on the short-term prognosis of elderly patients in the intensive care unit: a retrospective analysis based on the MIMIC-III database.

Elderly patients in the intensive care unit (ICU) often suffer from cardiac function impairment. Real-time monitoring of cardiac function and structural changes has important clinical significance. Transthoracic echocardiography (TTE) is a convenient, intuitive, and non-invasive real-time examination of the heart, and it has been widely used for intensive care patients. This study aims to analyze the impact of TTE on the prognosis of elderly patients in ICU. Data from elderly patients in the ICU was obtained from the MIMIC-III 1.4 database, and they were divided into a TTE examination group and a non-TTE examination group. The baseline data of the two groups were compared, and multiple regression analysis, propensity score (PS), compatibility analysis, and other methods were used to analyze the influence of TTE on the prognosis of elderly patients in ICU. A total of 8,952 elderly cases were included, comprising 3,280 cases (36.6%) in the TTE group and 5,672 cases (63.4%) in the non-TTE group. The SAPS score (20.34±5.34 vs. 18.74±5.2, t=13.889, P<0.001) and SOFA score (5.10±3.38 vs. 3.82±2.81, t=19.250, P<0.001) of patients in the TTE group were higher than those of non-TTE group. The rate of patients in the TTE group receiving mechanical ventilation (52.10% vs. 34.80%) and vasoactive drugs (29.30% vs. 15.00%) was significantly higher than that in the non-TTE group. In the PS score compatibility cohort, the 28-day mortality rate of patients in the TTE group was 23.4%, and the 28-day mortality rate of patients in the non-TTE group was 28.7%. The adjusted odd ratio (OR) value was 0.76 (95% CI: 0.65-0.87, P<0.001). Analysis of secondary endpoints showed that patients in the TTE group did not use mechanical ventilation and hypertension drugs for a longer period of time than those in the non-TTE group, and the TTE group patients had significantly more fluid input in the first three days after admission to the ICU than in the non-TTE group. TTE examination can reduce the 28-day mortality risk of elderly critically ill patients.

Venous thromboembolism risk factors and prophylaxis of elderly intensive care unit patients in a Chinese general hospital.

To analyze the venous thromboembolism (VTE) risk factors and prophylaxis of elderly patients in the intensive care unit (ICU). We retrospectively recruited 200 elderly patients with VTE and 234 non-VTE patients. VTE risk factors were got from data of all patients. The sensitivity and specificity of the Caprini scores and Padua scores were calculated. We use the receiver operating characteristic (ROC) curve and the area under the curve (AUC) to evaluate each score. We found that male sex, sepsis, being bedridden (>72 hours), pneumonia, history of deep vein thrombosis (DVT), diabetes mellitus, coronary heart disease, heart failure, glucocorticoid treatment, PaO2, hemoglobin (Hb), prothrombin time (PT), and international normalized ratio (INR), D-dimer (D-D), mechanical ventilation, and continuous renal replacement therapy (CRRT) were significantly associated with VTE in elderly ICU patients (P<0.05). For elderly patients in the ICU, the predictive ability of Caprini risk assessment model was better than that of the Padua risk assessment model. Among the high VTE risk elderly patients, the number of patients receiving mechanical prophylaxis in the high bleeding-risk group was higher than that in the low bleeding-risk group (P<0.0001). Elderly patients in the ICU have the highest risk of VTE and high bleeding risk; decisions concerning clinical prophylaxis should be made after appropriate information on the risk and benefit on an individual level is considered.

Comparing the predictive values of five scales for 4-year all-cause mortality in critically ill elderly patients with sepsis.

Several severity scales have been documented to predict the short-term mortality of septic patients. However, the predictive efficacies of different severity scales in the long-term mortality of the elderly have yet to be evaluated. In the retrospective study, a cohort of 4,370 elderly (≥65 years) septic patients admitted to the intensive care unit (ICU) were divided into three different age groups, i.e., the younger-old group (65 years ≤ age <75 years), the older-old group (75 years ≤ age <85 years) and the oldest-old group (age ≥85 years). Five scales, including the Simplified Acute Physiology Score II (SAPS II), the Oxford Acute Severity of Illness Score (OASIS), the Modified Logistic Organ Dysfunction System (MLODS), the Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA), were used for disease severity evaluations. The Kaplan-Meier survival curve, and the area under the receiver operating characteristic curve (AUC) were used to assess prognostic values of the long-term mortality of each severity scale. Compared with patients in the oldest-old group, those in the younger-old and the older-old groups had higher scores of SAPS II and OASIS, indicating more serious illness and worse prognosis. The survival time of patients was inversely related to age; the mean survival time was the longest in the youngerold group, followed by the older-old group and the oldest-old group. SAPS II had the best prognostic value (AUC: 0.648 for SAPS II, 0.579 for MLODS, 0.577 for SOFA, 0.612 for OASIS and 0.515 for SIRS, P<0.01) for the 4-year all-cause mortality. Elderly patients with an SAPS II score >43 had a lower survival rate regardless of age. The long-term mortality of elderly patients with sepsis is increased with age. SAPS II can better predict the long-term prognosis of elderly septic patients in ICU.

Propofol shows less negative effects on cognitive performances than dexmedetomidine in elderly intensive care unit patients.

Due to the improved clinical management of aging population and the consequently declined mortality among patients with critical illnesses, the number of survivors from intensive care units (ICUs) keeps rising. Studies to examine the association of cognitive impairment analgesic and sedation strategies would be beneficial to improve the quality of life of ICU survivors. A prospective clinical trial was designed to compare the effects of two drugs, propofol, and dexmedetomidine, on short-term cognitive impairment after sedation in elderly ICU survivors by evaluating the extent of independence limited by the dementia-related activities of daily livings (ADLs). The plasma concentrations of brain injury biomarkers including S100β and neuron-specific enolase (NSE) were determined using an enzyme immunoassay. There were 136 patients allocated into both the dexmedetomidine group and the propofol group, respectively, with matched demographic characteristics. The dementia scale of the patients in the dexmedetomidine group was significantly higher than the propofol group at weeks 1-4. Moreover, the changes in S100β and NSE concentrations in the dexmedetomidine group were significantly more pronounced than the propofol group. ICU patients who received dexmedetomidine intervention showed higher cognitive impairment than patients who received propofol, and this protective effect of propofol was not associated with the levels of brain injury markers S100β and NSE. Our study compared the effects of commonly used medications on short-term cognitive impairment in elderly ICU patients, which would aid the selection of sedation plan for the benefit of ICU patients.

Cognitive impairment after intensive care unit discharge: a Meta-analysis

To investigate the cognitive impairment after intensive care unit (ICU) discharge and provide theoretical basis for prevention and intervention. Studies about cognitive impairment after ICU discharge were retrieved in PubMed, Embase, Cochrane Library, Web of Science, Wanfang data, CNKI and SinoMed from their foundation to December 2019. The literature screening and data extraction were performed by two researchers independently, and the quality of different types of researches was evaluated using Cochrane Handbook 5.1.0, Newcastle-Ottawa scale (NOS) and agency for healthcare research and quality criteria (AHRQ). The Meta-analysis was performed by Stata 13.0 software. Sensitivity analysis was used to determine the reliability of the combined effect values. Funnel plot and Egger test were used to analyze publication bias. The non-parametric clipping was used to evaluate the impact of publication bias on the results. A total of 35 studies were enrolled, including 27 prospective cohort studies, 4 retrospective cohort studies, 2 randomized controlled trial (RCT) studies, 1 case-control study, and 1 cross-sectional study. Three literatures were published in Chinese and 32 were in English, which covered 13 countries, and a total of 102 504 ICU survivors were followed up successfully. Literature quality evaluation results showed that the NOS scores of 31 cohort studies were between 6 and 9, of which the case-control study scored 9. The quality grade of 2 RCT studies were both B. According to the AHRQ criteria, 1 cross-sectional study's design was scientifically rigorous and of high quality. Thirty-five studies reported that the overall incidence of cognitive impairment after ICU discharge ranged from 2.47% to 66.07%. For the multiple follow-ups studies, the first survey data was selected for Meta-analysis, and the results showed that the pooled incidence was 38.44% [95% confidence interval (95%CI) was 29.32-47.55]. Each study was removed for sensitivity analysis and the pooled results did not change much, which indicated that the results were reliable. The sub-group analysis was performed on different evaluation methods for cognitive impairment after ICU discharge, different types of ICU patients, and different follow-up time. The results showed that the pooled incidence of studies using neuropsychological test to evaluate cognitive impairment after ICU discharge was 31.42% (95%CI was 21.82-41.02), the pooled incidence of studies using questionnaires or scales was 38.75% (95%CI was 29.54-47.96), and the difference between the two groups was statistically significant (P < 0.01). The pooled incidence of cognitive impairment after ICU discharge in general ICU patients was 43.42% (95%CI was 30.88-55.95), acute respiratory distress syndrome (ARDS) patients' pooled incidence was 34.40% (95%CI was 23.02-45.79), and the pooled incidence of elderly ICU patients was 12.93% (95%CI was 8.48-17.37), the difference among the three groups was statistically significant (P < 0.01). The incidences of cognitive impairment < 1 year, 1 to 4 years, ≥ 5 years after ICU discharge were 43.30% (95%CI was 29.47-57.13), 34.21% (95%CI was 26.70-41.72), and 20.22% (95%CI was 4.89-35.55), respectively, and the differences among the three groups were statistically significant (P < 0.01). The funnel plot showed that the distribution of all studies was asymmetric, and the Egger test result also suggested that there might be publication bias (P < 0.05). The non-parametric clipping was used to estimate the impact of publication bias on the results, and the result showed that the difference in the incidence of cognitive impairment after ICU discharge before and after non-parametric clipping was large, suggesting that publication bias might influence the stability of the research results. The incidence of cognitive impairment after ICU discharge is relatively high and persistent for a long time, but diagnostic criteria of cognitive impairment and follow-up time are quite different. It is necessary to develop consistent evaluation criteria and rigorous designed research in the further.

Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country.

Background Aging is associated with a high risk of acute kidney injury (AKI), and the elderly with AKI show a higher mortality rate than those without AKI. In this study, we compared AKI outcomes between elderly and nonelderly patients in a university hospital in a developing country. Materials and Methods This retrospective cohort study included patients with AKI who were admitted to the medical intensive care unit (ICU) between January 1, 2012, and December 31, 2017. The patients were divided into the elderly (eAKI; age ≥65 years; n = 158) and nonelderly (nAKI; n = 142) groups. Baseline characteristics, comorbidities, principle diagnosis, renal replacement therapy (RRT) requirement, hospital course, and in-hospital mortality were recorded. The primary outcome was in-hospital mortality. Results The eAKI group included more females, patients with higher Acute Physiology and Chronic Health Evaluation II scores, and patients with more comorbidities than the nAKI group. The etiology and staging of AKI were similar between the two groups. There were no significant differences in in-hospital mortality (p=0.338) and RRT requirement (p=0.802) between the two groups. After adjusting for covariates, the 28-day mortality rate was similar between the two groups (p=0.654), but the 28-day RRT requirement was higher in the eAKI group than in the nAKI group (p=0.042). Conclusion Elderly and nonelderly ICU patients showed similar survival outcomes of AKI, although the elderly were at a higher risk of requiring RRT.

Trends in opioid use before critical illness among elderly patients in Ontario

PurposeTo assess temporal trends in pre-existing opioid exposure prior to hospitalization among elderly intensive care unit (ICU) patients and its association with adverse outcomes. Materials and methodsWe performed a population-based retrospective cohort study using health administrative data from the province of Ontario, Canada. We included all older adult (> 65 years) admissions to an ICU between April 2002 and March 2015. The exposure was opioid use before admission categorized as chronic use, intermittent use, and non-use. ResultsThe cohort included 711,312 elderly patient admissions to an ICU. Of these, 6.8% (n = 48,363) were chronic opioid users, 28.1% (n = 200,149) intermittent users, and 65.0% (n = 462,800) non-users. Compared with non-users, chronic opioid users and intermittent users had higher in-hospital mortality (adjusted odds ratio: 1.12, 95% CI, 1.09–1.15, p < 0.0001 for chronic users; adjusted odds ratio: 1.09, 95% CI, 1.07–1.11, p < 0.0001 for intermittent users), and a lower subdistribution hazard of time to hospital discharge, translating to a longer hospital length of stay (adjusted hazard ratio: 0.87, 95% CI, 0.85–0.88, p < 0.0001 for chronic users; adjusted hazard ratio: 0.93, 95% CI, 0.92–0.94, p < 0.0001 for intermittent users). ConclusionsAmong elderly ICU patients, opioid exposure prior to admission is prevalent and use is associated with higher in-hospital mortality.

Challenges and Barriers to Providing Care to Older Adult Patients in the Intensive Care Unit: A Qualitative Research.

BACKGROUND:Enhancing the quality of care for elderly patients needs an understanding of the challenges and obstacles experienced by the intensive care unit (ICU) staff in providing care.AIM:To explore the most challenging issues experienced by ICU staff, in particular, nurses, in the care of elderly patients in the general adult ICU.DESIGN:A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) were followed.METHODS:Based on theoretical sampling, we carried out 34 in-depth semi-structured interviews from two medical adult ICUs. Data analysis was carried out using qualitative conventional content analysis.RESULTS:Data analysis led to the identification of three interrelated categories and 12 subcategories. Three main categories were factors related to nurses’ attitude in elderly care, factors related to the system of care, and factors related to the models of patient care delivery. These categories came under the main theme of “Inappropriate and unfair system for elderly care”.CONCLUSION:The findings of this study increase scholarly understanding of challenges and barriers to providing care to elderly patients in the general adult ICU. We found that the provision of care to elderly patients is inappropriate and unfair. Various obstacles must be overcome to improve the care of these patients. For example, negative attitudes toward elder care, inappropriate environments, lack of resources, lack of knowledge and skills, a specialized model of care delivery, respect for humanity, care without considering patient age, and separating professional conflicts from patient care. These findings may be used by ICU’s caregivers and managers to improve the quality of care.IMPLICATIONS FOR PRACTICE:Various obstacles were documented that need to be overcome by hospital administrators, nursing managers, clinical nurses, nursing educators, nursing researchers to improve the care of elderly patients admitted to ICU.

Prevalence of delirium in elderly intensive care unit patients of a tertiary care medical college hospital

Background: Delirium is an acute disorder of attention and cognition. It occurs in 20% to 79% of hospitalized older patients. It is also common in ICU patients, occurring in 20% to 50% of non-mechanically ventilated ICU patients and in 60% to 80% of mechanically ventilated ICU patients. Hence delirium is a common, serious, and often fatal condition among older patients. The present study attempts to address the prevalence of Delirium in the Indian elderly population.Methods: A cross sectional study was conducted between January 2019 to June 2019 in a 50 bedded intensive care unit of a tertiary care hospital in Bengaluru, Karnataka. A total of 300 elderly patients aged 60 years and above, satisfying the inclusion criteria was included in the study. Patients were assessed for the presence of delirium within 24 hours of admission using Confusion Assessment Method for Intensive Care Unit (CAM-ICU). Various qualitative variables were expressed in terms of proportions.Results: Prevalence of delirium among elderly, non-ventilated ICU patients was 30% (90 out of 300 patients). Among them, 50 (55.5%) were females and remaining 40 (44.5%) were males. Mean age of the patients was 76 years. About 50 (55.5%) of them belonged to age group of 70-79 years. Most of the delirium patients (44.5%) belonged to hypoactive type of delirium followed by hyperactive (33.3%) and mixed (22.2%) type of delirium.Conclusions: Delirium in elderly ICU patients is significantly prevalent, which is a poor prognostic factor, leading to higher morbidity and mortality. Of the three subtypes- hypoactive delirium is the most common type of delirium among elderly. Yet, it is often overlooked or under-diagnosed. Hence clinicians and/or trained nursing staff managing the patients in the ICUs, should routinely screen the patients for delirium, using brief screening measures, which in turn can improve the patients’ outcome.

Clinical characteristics and nursing of lower extremity deep vein thrombosis in elderly patients in Intensive Care Unit of Neurology Department

Objective To analyze the clinical characteristics of lower extremity deep venous thrombosis (DVT) in elderly patients in Intensive Care Unit (ICU) of Neurology Department, and to provide evidence for early implementation of preventive strategies. Methods Totally 229 patients who were admitted to the ICU of Neurology Department in a hospital from March 2017 to October 2018 were collected as the participants of the study and divided into the elderly group (age≥60 years) and non-elderly group (age<60 years) according to their ages. Self-designed questionnaire was used to collect the patients' general information, relevant factors of the lower extremity DVT, and information of commonly seen problems in elderly population such as history of hypertension and diabetes. SPSS 22.0 was used for data analysis. Results Among the 229 patients, 97 were diagnosed as lower extremity DVT, the incidence was 42.4%. Among them, the number of lower extremity DVT in the elderly group was 62, and the incidence was 57.4%, while the number in the non-elderly group was 35, and the incidence was 28.9%, and there was statistically significant difference between the two groups (P 0.05) , and the main type of DVT was intramuscular venous thrombosis. Conclusions Ischemic cerebrovascular disease, high level fibrinogen accompanied by hypertension, diabetes mellitus and heart disease are the main factors of DVT formation in the lower extremity of elderly patients in ICU of Neurology Department. Reducing hormone use is the protective factor of DVT prevention in lower extremities. Neurological ICU needs to pay early attention to the occurrence of DVT in the lower extremities of the elderly, especially the intramuscular venous thrombosis. Early prevention and interventions should be initiated to reduce the incidence of DVT in the lower extremities of elderly patients in Neurological ICU. Key words: Venous thrombosis; Lower extremity; Department of Neurology; Intensive Care Unit

Infections in elderly intensive care unit patients

The elderly population is increasing in the developed world, therefore elderlies account for a considerable proportion of intensive care unit (ICU) admissions. A precise threshold for “elderly” is a matter of debate. The process of ageing is associated with physiological and functional alterations of the human body and organs that render elderly people vulnerable to infections. As a result of dysfunction of specific parts of immune response called immunosenescence, elderly patients may be threatened by severe infections. Chronic low-grade inflammation, termed inflammaging, is another contributor. In addition to these, comorbidities associated with increasing age, such as diabetes mellitus and immunosuppressive conditions pose an additive risk for infections and in some studies they were associated with increased mortality. Epidemiology of ICU infections may differ in elderlies, compared to other adults. Infections tend to be less microbiologically confirmed and site of infection may be obscure on presentation. The identified pathogens are frequently Gram-negative and particularly Enterobacteriaceae exhibiting a multidrug-resistant (MDR) phenotype. Multiple antibiotic prescriptions in this age-group, specific comorbidities (such as bronchiectasis or chronic obstructive pulmonary disease), residence in long term care facilities and frequent hospitalisations, are among others recognized risk factors for MDR infections. Data from two large European databases show that intra-abdominal infections are predominant among ICU infections in the elderly and Candida spp infections rank second, after Enterobacteriaceae. Age may pose important implications in treatment decisions. Organ derangements, physiological changes caused by increasing age and multiple concomitant medications call clinicians for vigilance about adverse events and toxicity. Despite all the above, elderlies in the ICU did not exhibit worse outcomes compared to younger counterparts in a straightforward manner. Studies however are heterogenous and most of them are single centers. As age is a continuous process, only analysis performed in subgroups of 65–74 (young-old elderlies), 75–84 (old elderlies) and >85 (old-old or oldest old elderlies) provides a better depiction of ICU outcomes. Most studies have shown a worse ICU outcome for the group of oldest-old elderlies, compared with young adults and elderlies in the range of 65 to 84 years of age. These data indicate that age per se may not represent a barrier in decisions concerning ICU admission and triage has to be done on an individual basis. However, epidemiological particularities of this age group should be taken into account in the selection of early and appropriate antimicrobial treatment, which will optimize patients’ outcomes.

Utilisation of medications among elderly patients in intensive care units: a cross-sectional study using a nationwide claims database

ObjectivesClinical practice guidelines for the management of pain and sedation in critically ill patients have been developed and applied; however, there is limited data on medication use among elderly patients....

Severe Acidemia, Leukocytosis and Low Hematocrit Levels at Admission as Mortality Predictors of Elderly Intensive Care Unit Patients

Severe Acidemia, Leukocytosis and Low Hematocrit Levels at Admission as Mortality Predictors of Elderly Intensive Care Unit Patients

Effects of different nutritional supports on nutrition metabolism and respiratory muscle strength in critical elderly patients in ICU

Objective To explore the effects of different nutritional pathways on nutrition metabolism and respiratory muscle strength in critical elderly patients in Intensive Care Unit (ICU) . Methods Totally 99 critical patients admitted in the ICU of Shandong Provincial Third Hospital between January and September 2017 and were equally randomized into enteral nutrition group (EN group) , parenteral nutrition group (PN group) and enteral nutrition plus parenteral nutrition group (EN+PN group) , which received nutritional support via different pathways. The patients'hemoglobin (Hb) , plasma albumin (ALB) and nitrogen balance were measured 7 days post nutritional support; the maximal inspiratory pressure (PImax) was monitored; and the nutritional status and respiratory muscle strength were compared in the patients receiving nutritional support via different pathways. Results After 7 days'nutritional support, EN+PN group showed better Hb (133.52±12.96) g/L, ALB (40.16±4.42) g/L and nitrogen balance (-4.31±1.67) g than PN group and EN group (F=5.602, 4.594, 2.854; P<0.05) . The PImax of EN+PN group was (-34.52±12.96) cmH2O, which was better than EN group and PN group (F=3.651, P<0.05) . Conclusions The combined EN and PN support has better effects on improving the nutritional status and respiratory muscle strength in critical elderly patients as compared to simply using EN or PN, and it also shows better short-term clinical outcomes than simply using EN or PN. Key words: Parenteral nutrition; Intensive care units; Enteral nutrition; Nutrition metabolism; Respiratory muscle strength

Frailty in elderly ICU patients in Greece: a prospective, observational study.

Of particular interest is the study of frailty syndrome in older patients in recent years. This syndrome is characterized by weight loss and muscle mass, a change in eating habits, movement and endurance, and a decline in cognitive function. The purpose of the study was the prevalence of frailty syndrome in subjects aged 65 years who were hospitalized in an intensive care unit (ICU) in Greece. This is a prospective, observational study. The study sample consisted of families or carers of 36 patients over 65 years of age. The study was conducted in a General Hospital in Greece, over a period of 1 year. The Clinical Frailty Scale (CFS) and the 5 criterions frailty phenotype were used. In addition, the severity of the patients with the APACHE II, SAPS II and SOFA scales was assessed. For the analysis of the data, the SPSS 19 for windows statistical package was used and more specifically descriptive statistics and correlations with parametric methods were performed. Thirty-six severely ill patients aged 65 years and over (22 women, 14 men) were studied. 25% of the patients had a positive frailty phenotype, 44% were at an early stage, while 30.6% had a frailty negative phenotype. A significant correlation between CFS and APACHE (P=0.041), age (P=0.033), sex (P=0.049) and ADL mobility index (P=0.001) was found to be significant. Concerning mortality, 36.1% of patients died in ICU, 11.1% died within the next 6 months and 38.9% were alive. The findings of the study highlighted the onset of frailty syndrome in ICU patients. The objective assessment of the frailty syndrome of the seriously ill patient as well as the prognostic markers provides a clearer picture of its out-of-hospital condition and contributes to the collection of information on the outcomes of the in-hospital treatment.

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients.

Computed tomography (CT) scans performed during routine hospital care offer the opportunity to quantify skeletal muscle and predict mortality and morbidity in intensive care unit (ICU) patients. Existing methods of muscle cross-sectional area (CSA) quantification require specialized software, training, and time commitment that may not be feasible in a clinical setting. In this article, we explore a new screening method to identify patients with low muscle mass. We analyzed 145 scans of elderly ICU patients (≥65 years old) using a combination of measures obtained with a digital ruler, commonly found on hospital radiological software. The psoas and paraspinal muscle groups at the level of the third lumbar vertebra (L3) were evaluated by using 2 linear measures each and compared with an established method of CT image analysis of total muscle CSA in the L3 region. There was a strong association between linear measures of psoas and paraspinal muscle groups and total L3 muscle CSA (R2 = 0.745, P < 0.001). Linear measures, age, and sex were included as covariates in a multiple logistic regression to predict those with low muscle mass; receiver operating characteristic (ROC) area under the curve (AUC) of the combined psoas and paraspinal linear index model was 0.920. Intraclass correlation coefficients (ICCs) were used to evaluate intrarater and interrater reliability, resulting in scores of 0.979 (95% CI: 0.940-0.992) and 0.937 (95% CI: 0.828-0.978), respectively. A digital ruler can reliably predict L3 muscle CSA, and these linear measures may be used to identify critically ill patients with low muscularity who are at risk for worse clinical outcomes.

Trends in short-term and 1-year mortality in very elderly intensive care patients in the Netherlands: a retrospective study from 2008 to 2014.

To describe the trends in short-term and long-term mortality in very elderly intensive care unit (ICU) patients between 2008 and 2014. A retrospective cohort study was conducted using data from the National Intensive Care Evaluation Foundation from 31 Dutch ICUs. Generalized linear mixed-effects models were used to determine the change in adjusted short-term mortality (ICU/hospital deaths) and long-term mortality (3, 6, and 12months after ICU admission) over the period 2008-2014 in very elderly patients and in patients less than 80years old admitted to the ICU. A total of 216,196 patients admitted to 31 ICUs in the period from 2008 to 2014 were included in the study, including 28,284 (13.1%) very elderly patients (80years or older). Follow-up data for determination of 3-, 6-, and 12-month mortality were available for, respectively, 210,005 (97.1%), 202,551 (93.7%), and 176,847 (81.8%) ICU admissions. The crude ICU and in-hospital mortality decreased, respectively, from 17.6% to 13.0% and from 30.7% to 21.0%. The annual risk-adjusted ICU and in-hospital mortality of very elderly patients (adjusted for APACHE III score, comorbidities, and admission type) decreased significantly during the study period [adjusted odds ratio 0.97 (0.95-0.99) and 0.92 (0.91-0.93), respectively]. Additionally, the annual risk-adjusted 3-, 6-, and 12-month mortality decreased significantly from 2008 to 2014 [adjusted odds ratio 0.96 (0.95-0.97), 0.96 (0.94-0.97), and 0.97 (0.95-0.98), respectively]. A similar significant annual decrease in risk-adjusted short-term and long-term mortality was observed in patients aged less than 80years. Both short-term and long-term risk-adjusted mortality decreased significantly during the study period in both very elderly ICU patients and patients aged less than 80years in the Netherlands. This study clearly shows that in our setting very elderly patients benefit almost as much as their younger counterparts from improvement in quality of care over time.