Critically Ill Very Elderly Patients Admitted to ICU's Clinical Trial
Official title:
Treatment Intensity and Factors Predicting Short and Long Term Outcomes in Elderly and Very Elderly Patients Admitted to Intensive Care Units
1. Patients greater than 90 years of age will have poorer outcomes in terms of mortality
than younger patients controlling for disease and acuity
2. Patients greater than 90 years old will consume more resources than younger patients
controlling for disease and acuity
3. Patients greater than 90 years old will show lower levels of function than younger
patients controlling for disease and acuity
4. Patients greater than 90 years old will show lower levels of HRQOL at 90-120 days post
ICU discharge than younger patients controlling for disease and acuity
Elderly patients make up between 26% and 51% of patients who are admitted to ICUs. The
proportion of individuals in North America aged > 65 is projected to increase to 20% of the
population by 2026. As population demographics change, and as new technologies,
pharmaceuticals, and interventions prolong lives, the proportion of elderly patients
admitted to ICUs and surviving ICU stay will continue to increase. Studies that have
examined only ICU or hospital survival as an outcome have had variable results. Few studies
have demonstrated that elderly ICU patients experience higher mortality rates, while others
have demonstrated that age alone, when adjusted for other factors, is not an important
prognostic indicator among elderly patients admitted to the intensive care units (ICU).
However, age is still used as an important criteria for admission to ICUs. Most studies
reviewed have looked at patients sixty-five to ninety years old. To our knowledge only two
studies to date have addressed this issue among patients older than 90 to an ICU, both were
retrospective.
With increasing age there is a parallel increase in health care costs. The use of expensive
technology and procedures in the very elderly is fast becoming a major concern. Data on
resource allocation and treatment intensity in the (90+) subgroup is sparse.
Beyond mortality and cost, health-related quality of life (HRQOL) is a fundamentally
important end point of medical care. Few studies have addressed outcomes in terms of HRQOL
and functional status of elderly following discharge the from critical care unit. These
studies were limited by small number of subjects enrolled, retrospective design, and lack of
validated tool to assess HRQOL.
We plan to prospectively collect data to look at determinants of treatment intensity,
outcome, and resource allocation in elderly patients ages 65 and above admitted to the ICU
with care taken to including as many patients in the age interval above 90 years of age. We
will also assess HRQOL and functional status in very elderly patients who survive admission
and are discharged from the hospital.
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Observational Model: Cohort, Time Perspective: Prospective