Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study.

INTRODUCTION: Long-term outcomes of elderly patients after medical ICU care are little known. The aim of the study was to evaluate functional status and quality of life of elderly patients 12 months after discharge from a medical ICU. METHODS: We prospectively studied 112/230 healthy elderly patients (≥ 65 years surviving at least 12 months after ICU discharge) with full functional autonomy without cognitive impairment prior to ICU entry. The main diagnoses at admission using the Acute Physiology and Chronic Health Evaluation III (APACHE III) classification diagnosis and length of ICU stay and ICU scores (APACHE II, Sepsis-related Organ Failure Assessment (SOFA) and OMEGA) at admission and discharge were collected. Comprehensive geriatric assessment included the presence of the main geriatric syndromes and the application of Lawton, Barthel, and Charlson Indexes and Informant Questionnaire on Cognitive Decline to evaluate functionality, comorbidity and cognitive status, respectively. The EuroQol-5D assessed quality of life. Data were collected at baseline, during ICU and ward stay and 3, 6 and 12 months after hospital discharge. Paired or unpaired T-tests compared differences between groups (continuous variables), whereas the chi-square and Fisher exact tests were used for comparing dichotomous variables. For variables significant (P ≤ 0.1) on univariate analysis, a forward multiple regression analysis was performed. RESULTS: Only 48.9% of patients (mean age: 73.4 ± 5.5 years) were alive 12 months after discharge showing a significant decrease in functional autonomy (Lawton and Barthel Indexes) and quality of life (EuroQol-5D) compared to baseline status (P < 0.001, all). Multivariate analysis showed a higher Barthel Index and EQ-5D vas at hospital discharge to be associated factors of full functional recovery (P < 0.01, both). Thus, in patients with a Barthel Index ≥ 60 or EQ-5D vas ≥ 40 at discharge the hazard ratio for full functional recovery was 4.04 (95% CI: 1.58 to 10.33; P = 0.005) and 6.1 (95% CI: 1.9 to 19.9; P < 0.01), respectively. Geriatric syndromes increased after ICU stay and remained significantly increased during follow-up (P < 0.001). CONCLUSIONS: The survival rate of elderly medical patients 12 months after discharge from the ICU is low (49%), although functional status and quality of life remained similar to baseline in most of the survivors. However, there was a two-fold increase in the prevalence of geriatric syndromes.

Mortality in healthy elderly patients after ICU admission.

PURPOSE: The aim of this study was to assess mortality in healthy elderly patients after non-elective medical ICU admission and to identify predictive factors of mortality in these patients. METHODS: Patients >or=65 years living at home and with full-autonomy (Barthel index, BI > 60), without cognitive impairment, and non-electively admitted to a medical ICU were prospectively recruited. A full comprehensive geriatric assessment was made with validated scales. RESULTS: A total of 230 patients were included, 110 (48%) between 65 and 74 years and 120 (52%) >or=75 years. No significant differences were observed between the two groups in premorbid functional and cognitive status, main diagnosis at ICU admission, APACHE II and SOFA scores, use of mechanical ventilation or haemodialysis or length of ICU stay. Over a mean follow-up of 522 days (range 20-1,170 days) the cumulative mortality of the whole group was 55%, being significantly higher in older subjects (62 vs. 47%; P = 0.024). On multivariate analysis, only parameters related to quality of life (QOL) and functional status were independent predictors of cumulated mortality (P < 0.01, both). Thus, in patients with EQ-5D(vas) (<70) or baseline Lawton index (LI) (<5) the hazard ratio for cumulated mortality was 2.45 (95% CI: 1.15-5.25; P = 0.03) and 4.10 (95% CI: 1.53-10.99; P = 0.006), respectively, compared to those with better scores. CONCLUSIONS: Healthy elderly non-elective medical patients admitted to the ICU have a high mortality rate related to premorbid QOL. The LI and/or EQ-5D(vas) may be useful tools to identify patients with the best chance of survival.

Relación entre la pérdida sensorial y la capacidad funcional en personas mayores de 89 años. Estudio NonaSantfeliu / Relationship between sensory impairment and functional status in nonagenarians. The NonaSantfeliu Study

Objetivo: la alteración de los órganos sensoriales es frecuente en las personas mayores. Se analiza la prevalencia de deterioro de la función visual y auditiva en personas mayores de 89 años, y la relación entre éstas y la capacidad para realizar actividades de la vida diaria. Material y métodos: se obtienen datos del estudio poblacional NonaSantfeliu: sociodemográficos, capacidad para realizar actividades básicas con el índice Barthel (IB) e instrumentales con el índice Lawton y Brody (IL), cognición con el miniexamen cognitivo de Lobo (MEC) y comorbilidad con el índice de Charlson. Se valoró la capacidad de visión de cerca con tablas equivalentes de Snellen y la capacidad auditiva con el test del susurro. Resultados: participaron en el estudio un total de 186 pacientes nonagenarios, con una edad media de 93,06 años (76,5% mujeres), el 74% vivía en su domicilio, el resto estaba institucionalizado. En el 38% la visión de cerca era patológica y en otro 30%, correcta, aunque corregida con gafas. En el 40% había un déficit auditivo no corregido y en otro 8%, corregido con audífono. En el 18% había un déficit doble, y en un 5,3%, una doble corrección ortopédica. Las personas con déficit visual o doble déficit sensorial tenían un menor IB, IL y MEC, y en ambos casos en el análisis multivariante se mantenía asociación con el IL (p < 0,001, odds ratio [OR] = 1,859, intervalo de confianza [IC] del 95%, 1,441-2,398; p < 0,001, OR = 1,995, IC del 95%, 1,320-3,016, respectivamente). Conclusiones: la pérdida en la visión y audición es frecuente en las personas mayores de 89 años. La capacidad para realizar actividades instrumentales está disminuida en las personas con pérdida visual o con doble pérdida sensorial

Objective: alterations in the sense organs are frequent in the elderly. Our aim was to analyze the status of visual function and hearing in nonagenarians in order to evaluate the relationship between sensory impairment and the ability to perform basic or instrumental activities of daily life. Material and methods: data were obtained from the NonaSantfeliu population-based study: sociodemograhic variables were collected. Functional status was determined by the Lawton-Brody Index (LI) and Barthel Index (BI) and cognition by the Spanish version of the Mental State Examination (Miniexamen cognitivo de Lobo [MEC]). Comorbidity was evaluated using the Charlson Index. Near visual acuity was evaluated by the Snellen test, and auditory acuity was assessed with the whisper test. Results: the sample was composed of 186 nonagerians, with a mean age of 93.06 (3.1) years; 76.5% were women. Seventy-four percent lived at home and the remainder lived in nursing homes. Visual impairment was found in 38%, and hearing impairment in 40%. Combined visual and hearing impairment was found in 18% and devices to correct both impairments were required in 5.3%. Nonagenarians with visual or combined impairment had poor LI, BI and MEC values. In multivariate analyses a lower LI was associated with visual impairment (p < 0.001, odds ratio [OR] = 1.859, 95% confidence interval [CI] 1.441-2.398) and combined impairment (p < 0.001, OR = 1.995, 95% CI 1.320-3.016). Conclusions: impairment of vision and hearing ability are common in nonagenarians. The ability to perform instrumental activities of daily life is decreased due to visual and combined sensory impairment in this population