Objective. —To evaluate the long-term mortality and morbidity of critically ill elderly patients requiring intensive care. Design. —Prospective comparison of outcome of critically ill patients aged 75 years and older with patients aged 65 to 74 years. Patients. —Critically ill patients aged 65 years and older who required intensive care and who were recruited during a 3-month period. Main Outcome Measures. —Duration of hospitalization, hospital charges, procedures used in the intensive care unit, mortality in the hospital and during the follow-up period, and quality of life of survivors during the follow-up period. Results. —Ninety-seven patients were included in the study; 54 were 75 years or older and 43 were aged 65 to 74 years. No significant difference was noted between the two groups for length of stay in the hospital, hospital charges, or mortality at 1 year. Severity of illness, as assessed by Acute Physiology and Chronic Health Evaluation score at the time of intensive care unit admission, was a better predictor of survival than age. Quality of life, as assessed by activities of daily living, perceived quality of life, and Center for Epidemiologic Studies—Depression score, were not significantly different in either group at 1, 6, and 12 months after discharge from the hospital. Most patients in both groups described their quality of life as adequate and were willing to receive intensive care again, if necessary. Conclusion. —Age alone is not an adequate predictor of long-term survival and quality of life in critically ill elderly patients. (JAMA. 1993;269:3119-3123)

Long-term outcome of critically ill elderly patients requiring intensive care

The literature on outcomes of intensive care for the elderly with regard to intensive care unit utilization, mortality, hospital costs and charges, and quality of life after intensive care were reviewed. Publications in the English literature, which evaluated intensive care and included elderly populations, were obtained from review of Index Medicus and MEDLINE. We conclude that age alone is not an acceptable predictor of critical illness with regard to mortality and quality of life of survivors. A therapeutic trial and appropriately discontinuing life support may lead to better utilization of intensive care. Additional data are needed on long-term mortality and quality of life after hospital discharge. (Arch Intern Med. 1995;155:1013-1022)

Intensive care for critically ill elderly: mortality, costs, and quality of life. Review of the literature.

https://www.amjmed.com/article/0002-9343(83)90340-6/pdf

Precedents for meaningful recovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy.

ObjectiveTo present guidelines for writing admission and discharge policies for adult intermediate care units.Data SourcesOpinion of practitioners with experience and expertise in managing critical and intermediate care units.Data SynthesisConsensus was reached regarding the characteristics of patie

Guidelines on admission and discharge for adult intermediate care units. American College of Critical Care Medicine of the Society of Critical Care Medicine.

• Quantitative methods to enhance clinical judgment would be of tremendous benefit to physicians caring for the critically ill. The ability of physicians to predict outcome is a logical standard on which to base the prospective evaluation of a prediction rule intended for this clinical use. The APACHE ( a cute p hysiology and c hronic h ealth e valuation)–II score was compared with critical care physicians' prediction of outcome for a group of patients in a medical intensive care unit. Physicians were significantly better in predicting outcome in the critically ill. However, the APACHE-II score was still a good predictor of outcome in the intensive care unit and, according to analysis using Bayes' theorem, might still be a useful test to support physicians' judgment, especially in patients with a predicted mortality risk of less than 30%. ( Arch Intern Med . 1989;149:1083-1086)

Prediction of Outcome From Critical Illness: A Comparison of Clinical Judgment With a Prediction Rule

Fifty-eight consecutive patients admitted to the ICU requiring ventilatory support for respiratory failure were studied. The Therapeutic Intervention Scoring System (TISS) was used daily as an objective measure of the severity of critical illness in each patient. Patients who survived (27 of 58) 8-10 months after admission to the ICU were interviewed in their homes to assess the outcome of their illness. Most survivors were functioning at or above their premorbid level with respect to their activities of self care and community living. Survivors had minimal recall of the pain and anguish of their ICU experience. The financial cost of care was estimated. Of the total ICU cost, 40% was expended on the 27 survivors. The TISS alone could not distinguish survivors from nonsurvivors in this patient population. The major factor determining the outcome of the illness was the age of the patient. More information on the outcome of critical illness in elderly patients is needed.

Byrick Rj

Papers

Cost-effectiveness of intensive care for respiratory failure patients.