Short-term outcomes in older intensive care unit patients with dementia

Vanderbilt University, Нашвилл, Michigan, United States
Critical Care Medicine (Impact Factor: 6.31). 07/2005; 33(6):1371-6. DOI: 10.1097/01.CCM.0000165558.83676.48
Source: PubMed

ABSTRACT To determine the impact of dementia on the outcomes of intensive care unit (ICU) care and use of ICU interventions among older patients.
Prospective observational cohort study.
Urban university teaching hospital.
Patients were 395 patients age >/=65 consecutively admitted to a medical ICU.
Dementia was determined by a previously validated proxy measure, the Modified Blessed Dementia Rating Scale. We chose cut points to focus on patients with moderate-severe dementia at baseline. Our primary outcomes included length of mechanical ventilation and ICU and hospital length of stay. Secondary outcomes included ICU readmission, changes in code status, discharge location, mortality, and use of ICU interventions. Medical record abstraction was performed to determine the rates of ICU outcomes, use of ICU interventions, and potential confounders. Our study documented a prevalence of moderate-severe dementia of 17% in patients age >/=65 admitted to the ICU. Patients with dementia were significantly older (80 vs. 76), more likely to be female (65% vs. 52%), and more likely to be admitted from a nursing home (46% vs. 11%). Patients with dementia had significantly higher Acute Physiology and Chronic Health Evaluation II scores on admission to the ICU (25 vs. 23). Patients with dementia were more likely to have their code status changed to less aggressive in the ICU (24% vs. 14%). There was no significant difference in readmission to the ICU, discharge location, ICU or hospital mortality rate, or use of ICU interventions between patients with and without dementia.
Our study documents no difference in outcomes from ICU care in older patients with and without dementia. There was no increased short-term mortality rate in older patients with dementia compared with those without dementia after admission to the ICU. Presumptions that outcomes from critical care are less favorable in patients with dementia should not drive treatment decisions in the ICU.

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Available from: Margaret A Pisani, Jan 21, 2015
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    • "The hospital mortality for this group of older patients was higher than the 13.8% described by Higgins et al in 2007 and similar to the mortality of 39% reported by Chelluri et al in 1993 for older ICU patients [2,21]. Additionally, the in-hospital mortality was equivalent to that reported by Pisani et al in a separate cohort of 395 patients [22]. Our cohort had slightly lower mortality than the cohorts reported by Tabah and Boumedil; however, our patients were on average younger [4,23]. "
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    ABSTRACT: Accurate measurement of quality of life in older ICU survivors is difficult but critical for understanding the long-term impact of our treatments. Activities of daily living (ADLs) are important components of functional status and more easily measured than quality of life (QOL). We sought to determine the cross-sectional associations between disability in ADLs and QOL as measured by version one of the Short Form 12-item Health Survey (SF-12) at both one month and one year post-ICU discharge. Data was prospectively collected on 309 patients over age 60 admitted to the Yale-New Haven Hospital Medical ICU between 2002 and 2004. Among survivors an assessment of ADL's and QOL was performed at one month and one-year post-ICU discharge. The SF-12 was scored using the version one norm based scoring with 1990 population norms. Multivariable regression was used to adjust the association between ADLs and QOL for important covariates. Our analysis of SF-12 data from 110 patients at one month post-ICU discharge showed that depression and ADL disability were associated with decreased QOL. Our model accounted for 17% of variability in SF12 physical scores (PCS) and 20% of variability in SF12 mental scores (MCS). The mean PCS of 37 was significantly lower than the population mean whereas the mean MCS score of 51 was similar to the population mean. At one year mean PCS scores improved and ADL disability was no longer significantly associated with QOL. Mortality was 17% (53 patients) at ICU discharge, 26% (79 patients) at hospital discharge, 33% (105 patients) at one month post ICU admission, and was 45% (138 patients) at one year post ICU discharge. In our population of older ICU survivors, disability in ADLs was associated with reduced QOL as measured by the SF-12 at one month but not at one year. Although better markers of QOL in ICU survivors are needed, ADLs are a readily observable outcome. In the meantime, clinicians must try to offer realistic estimates of prognosis based on available data and resources are needed to assist ICU survivors with impaired ADLs who wish to maintain their independence. More aggressive diagnosis and treatment of depression in this population should also be explored as an intervention to improve quality of life.
    Health and Quality of Life Outcomes 02/2011; 9(1):9. DOI:10.1186/1477-7525-9-9 · 2.12 Impact Factor
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    • "The high rate and underrecognition of preexisting cognitive impairment in older adults admitted to an SICU is clinically significant. Not only is dementia an important risk factor for development of delirium in this population (McNicoll et al., 2003), it has also been shown to be a factor that influences healthcare providers to make the decision to change a patient's code status to a less aggressive level (Pisani et al., 2005). Information about preexisting cognitive function is necessary to evaluate a patient's decision-making capacity, to assess ability to provide informed consent, and for ongoing evaluation of mental status changes throughout hospitalization (Pisani, McNicoll, & Inouye, 2003). "
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    ABSTRACT: To examine the frequency and course of delirium in older adults admitted to a surgical intensive care unit (SICU). Prospective, observational cohort study of 114 English-speaking participants and their surrogates, aged 65 and older, admitted to an SICU, and managed by a surgical critical care service. Chart reviews and surrogate interviews were conducted within 24 hours of SICU admission to collect information regarding evidence of dementia using the short form of the Informant Questionnaire on Cognitive Decline in the Elderly. Participants were also screened for delirium daily throughout their hospitalization with either the Confusion Assessment Method-ICU (CAM-ICU) while in the SICU or the CAM while on medical/surgical units. In this population of older adults, 18.4% had evidence of dementia on admission to the SICU. Few older adults (2.6%) were admitted to the hospital with evidence of preexisting delirium, but 28.3% developed delirium in the SICU and 22.7% during the post-SICU period. A total of 52 of 114 (45.6%) participants were delirious sometime during their hospital stay or 24 hours before hospital admission. Episodes of deep sedation and nonarousal were uncommon, occurring in only 9.7% of the sample. Older adults admitted to SICUs were at high risk for developing delirium during hospitalization. Further research is needed to elucidate the risk factors for, and outcomes of, delirium in this uniquely vulnerable population.
    Journal of Nursing Scholarship 02/2007; 39(2):147-54. DOI:10.1111/j.1547-5069.2007.00160.x · 1.64 Impact Factor
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