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The following is a summary of “Evolution of Clinical Characteristics and Outcomes of Critically Ill Patients 90 Years Old or Older Over a 12-Year Period: A Retrospective Cohort Study,” published in the June 2024 issue of Critical Care by Daniels et al.
As the global population ages, ICUs will see a rise in patients 90 years and older, necessitating research on evolving comorbidities and outcomes.
Researchers started a retrospective study to investigate the evolving clinical characteristics and survival outcomes of patients aged 90 years or older admitted to the ICU over a defined period.
Researchers started a retrospective analysis examining critically ill patients aged 90 years or older admitted to the ICUs of a single academic hospital in Germany from January 2008 to April 2019.
The result showed that only 1,108 of the 92,958 individuals with critical illness were found to be elderly. This population increased from 0.90% (n=391) in the first study period (2008-2013) to 1.44% (n=717) in the second (2013-2019). Interestingly, despite similar demographics, a potential decrease was observed in the severity of the illness between the periods. This is reflected in the Charlson Comorbidity Index, which was higher in the first period (1 [interquartile range, 1–3])) than in the second period (1 [0–2]; P=0.052). Similarly, The Simplified Acute Physiology Score (SAPS II) increased during the first period (38 [29–49]) than during the later period (35 [27–45]; P=0.005). Notably, the use of vasopressor therapy remained consistent at around 40% (n=158 vs. n=310) across both periods (P=0.363). While ventilator use remained similar (37% or n = 146 vs. 34% or n = 243) respectively (P=0.250), ICU stay shortened in the later period (1.4 vs. 1.7 days, P=0.002). Mortality rates in ICU (18% vs. 18% P=0.861) and hospital (31% vs. 29%) were comparable across periods. Interestingly, 1-year mortality improved in the second period (61% vs. 56%, P=0.029). The factors linked to mortality included illness severity (SAPS II), admission reason, ventilator use, and vasopressor use.
Investigators concluded that despite stable clinical profiles and short-term outcomes, ICU admissions for patients of older ages have improved long-term survival in recent years.
