Age has little impact on critical care outcomes
MedWire News: Age is not an independent predictor of mortality among patients in a medical high-dependency unit (MHDU), report UK researchers.
Previous studies have indicated that age has only a small effect on outcomes of patients in intensive care units (ICUs), relative to the impact of illness severity and acute physiology.
"This study adds data from a dedicated MHDU, identifying patients who were neither stepped up nor stepped down from the ICU," Elizabeth Hood (Russells Hall Hospital, Dudley, UK) and colleagues.
MHDUs admit only patients with medical diagnoses. "This is a relatively under-studied type of unit and so these data are useful for planning and comparison," notes the team.
The 100 patients in the team's study were admitted to the MHDU for a variety of complaints, most commonly respiratory failure from pneumonia, exacerbations of chronic obstructive pulmonary disease or asthma, sepsis, and gastrointestinal bleeding.
Overall, 21% of patients died within 30 days of admission, the researchers report in the British Journal of Anaesthesia.
In all, 41% of patients were younger than 65 years, and 12% died; 29% were aged 65-74 years, and 31% died; and 30% were aged 75 years or older, and 23% died. The mortality differences between the groups were not statistically significant.
Age also did not impact on mortality among patients classified as having a high or low Acute Physiology and Chronic Health Evaluation (APACHE) II score (cutoff 25 points).
The only independent predictors of mortality were illness severity and pre-admission functional status, reports the team. After accounting for confounders, patients requiring support for two or more organs were 10.8 times more likely to die than were those needing less support. Also, patients who needed moderate care assistance or were admitted from a nursing home were 4.4 times more likely to die than those with better functional status.
Most patients regained their premorbid functional status, and age did not affect their chances of making a full functional recovery.
Hood et al note that their study is prone to selection basis, as patients who were reviewed by a critical care team and moved to the MHDU were likely "physiologically better and socially well supported" relative to those who remained on the ward.
"Based on such results, rather than concluding that age should be no barrier to high dependency unit admission, rather selected elderly patients with good pre-morbid functional status may benefit from higher level care as much as younger patients," they say.
"In a resource-limited environment, elderly patients should be judged individually based upon illness severity, quality of life, and likely critical care requirements. Some have advocated a trial of therapy with subsequent appropriate discontinuation of life support if necessary."
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By Eleanor McDermid