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


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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    • "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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