Yale University. US: A growing number of older adults are surviving visits to hospital
intensive care units (ICUs), but many emerge with disabilities such as
impaired walking and poor overall function. A new study by Yale School
of Medicine researchers shows that the level of disability the year
before an ICU visit can predict post-ICU disability and death.
The results appear in the Feb. 9 issue of JAMA Internal Medicine.
First author Dr. Lauren Ferrante
and her colleagues at Yale evaluated 291 participants who were admitted
to an ICU over the 14+ years of the larger Precipitating Events Project
(PEP) longitudinal study of adults aged 70 and older in Greater New
Haven, Conn. All participants had monthly assessments of function,
during which they were asked if they needed help to complete activities
of daily living, such as bathing and dressing; instrumental activities
of daily living, such as meal preparation and taking medications; and
mobility activities, such as walking a quarter mile.
The team
found that there were three distinct functional trajectories (or levels
of disability) in the year before and after ICU admission. They
determined the probability of an older person transitioning to a worse
functional trajectory after an ICU admission, and also identified
factors associated with death within one year of being admitted to the
ICU.
“We calculated the probability of an older person
transitioning to a worse functional trajectory in the ICU setting,” said
Ferrante, a senior fellow in the Pulmonary, Critical Care, and Sleep
Medicine program, and a research fellow in the Geriatric Clinical
Epidemiology and Aging-Related Research program at Yale. “We found that
more than half of older persons transition to a worse functional
trajectory or die within 30 days of admission.”
The team also
found that the pre-ICU functional trajectories of mild-to-moderate and
severe disability were associated with more than double and triple the
risk of death within one year of ICU admission, respectively, compared
to those with minimal disability.
Ferrante said this suggests the
need for a focus on maintaining function in older adults in the ICU and
after discharge, and for new rehabilitation strategies for these
patients, particularly those who have transitioned to a worse functional
trajectory. “Our results also suggest that older adults with severe
disability in the year before ICU admission may want to consider a
palliative approach while in the ICU,” she added.
Other authors on
the study include Dr. Thomas Gill, Dr. Margaret Pisani, Terrence
Murphy, Dr. Evelyne Gahbauer, and Linda Leo-Summers.
The study was
funded by grants from the National Institute on Aging, the American
Federation on Aging Research, which supports The John A. Hartford
Foundation Center of Excellence in Geriatric Medicine and Training at
Yale, and the National Heart, Lung, and Blood Institute. The research
was conducted at the Yale Pepper Center/Program on Aging.
Citation: JAMA Internal Medicine