Abstract
Elderly patients (age ≥65 years) currently comprise 42–52 % of ICU admissions and account for almost 60 % of all ICU days in the United States. The “oldest old” (those age ≥85) are the most rapidly growing elderly age group. The aging of the population will lead to an increasing demand for critical care resources. In addition, 40 % of Medicare patients who die are admitted to the ICU during their terminal illness, accounting for 25 % of all Medicare expenditures. Increasing age is associated with a progressive increase in the risk of ICU death. Thus, a significant amount of critical care resources are used at the end of life in elderly patients. Studies are needed to determine which elderly patient will benefit most from ICU care.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
http://www.census.gov/compendia. Accessed 1 June 2012.
http://www.census.gov/population/socdemo/statbriefs/agebrief.html. Accessed 1 June 2012.
Marik PE. Management of the critically ill geriatric patient. Crit Care Med. 2006;34(Suppl):S176–82.
Nguyen YL, Angus DC, Boumendil A, Guidet B. The challenge of admitting the very elderly to intensive care. Ann Intensive Care. 2011;1:29.
Bagshaw SM, Webb SA, Delaney A, George C, Pilcher D, Hart GK, Bellomo R. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care. 2009;13(2):R45.
Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, Davido A, Masmoudi R, Doumenc B, Pateron D, Garrouste-Orgeas M, Somme D, Simon T, Aegerter P, Guidet B, ICE-CUB study group. Variability of intensive care admission decisions for the very elderly. PLoS One. 2012;7(4):e34387. doi:10.1371/journal.pone.0034387. Epub 2012 Apr 11.
Khouli H, Astua A, Dombrowski W, Ahmad F, Homel P, Shapiro J, Singh J, Nallamothu R, Mahbub H, Eden E, Delfiner J. Changes in health-related quality of life and factors predicting long-term outcomes in older adults admitted to intensive care units. Crit Care Med. 2011;39(4):731–7. doi:10.1097/CCM.0b013e318208edf8.
Wunsch H, Guerra C, Barnato AE, Angus DC, Li G, Linde-Zwirble WT. Three-year outcomes for Medicare beneficiaries who survive intensive care. JAMA. 2010;303(9):849–56. doi:10.1001/jama.2010.216.
Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF, American College of Surgeons National Surgical Quality Improvement Program; American Geriatrics Society. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453–66. doi:10.1016/j.jamcollsurg.2012.06.017. Epub 2012 Aug 21.
Roch A, Wiramus S, Pauly V, Forel JM, Guervilly C, Gainnier M, Papazian L. Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care. 2011;15(1):R36. doi:10.1186/cc9984. Epub 2011 Jan 24.
Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonghe B, Carlet J. Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med. 2000;28(10):3389–95.
Taylor MD, Tracy JK, Meyer W, Pasquale M, Napolitano LM. Trauma in the elderly: intensive care unit resource use and outcome. J Trauma. 2002;53(3):407–14.
Peschman J, Neideen T, Brasel K. The impact of discharging minimally injured trauma patient: does age play a role in trauma admission? J Trauma. 2011;70(6):1331–6. doi:10.1097/TA.0b013e31821693e2.
Hranjec T, Sawyer RG, Young JS, Swenson BR, Calland JF. Mortality factors in geriatric blunt trauma patients: creation of a highly predictive statistical model for mortality using 50,765 consecutive elderly trauma admissions from the national sample project. Am Surg. 2012;78(12):1369–75.
Meldon SW, Reilly M, Drew BL, Mancuso C, Fallon Jr W. Trauma in the very elderly: a community-based study of outcomes at trauma and nontrauma centers. J Trauma. 2002;52(1):79–84.
Bennett KM, Scarborough JE, Vaslef S. Outcomes and health care resource utilization in super-elderly trauma patients. J Surg Res. 2010;163(1):127–31. doi:10.1016/j.jss.2010.04.031. Epub 2010 May 21.
Sarkar B, Brunsvold ME, Cherry-Bukoweic JR, Hemmila MR, Park PK, Raghavendran K, Wahl WL, Wang SC, Napolitano LM. American College of Surgeons’ Committee on Trauma performance improvement and patient safety program: maximal impact in a mature trauma center. J Trauma. 2011;71(5):1447–53. doi:10.1097/TA.0b013e3182325d32; discussion 1453–4.
Frederickson TA, Renner CH, Swegle JR, Sahr SM. The cumulative effect of multiple critical care protocols on length of stay in a geriatric trauma population. J Intensive Care Med. 2013;28(1):58–66. doi:10.1177/0885066611432420. Epub 2012 Jan 23.
Mangram AJ, Mitchell CD, Shifflette VK, Lorenzo M, Truitt MS, Goel A, Lyons MA, Nichols DJ, Dunn EL. Geriatric trauma service: a one-year experience. J Trauma Acute Care Surg. 2012;72(1):119–22. doi:10.1097/TA.0b013e318241f0ba.
Bourg P, Richey M, Salottolo K, Mains CW. Development of a geriatric resuscitation protocol, utilization compliance, and outcomes. J Trauma Nurs. 2012;19(1):50–6. doi:10.1097/JTN.0b013e31822b80f5.
Fallon Jr WF, Rader E, Zyzanski S, Mancuso C, Martin B, Breedlove L, DeGolia P, Allen K, Campbell J. Geriatric outcomes are improved by a geriatric trauma consultation service. J Trauma. 2006;61(5):1040–6.
Lenartowicz M, Parkovnick M, McFarlan A, Haas B, Straus SE, Nathens AB, Wong CL. An evaluation of a proactive geriatric trauma consultation service. Ann Surg. 2012;256(6):1098–101. doi:10.1097/SLA.0b013e318270f27a.
ACS TQIP Geriatric trauma management guidelines. 2013. http://www.facs.org/trauma/ntdb/tqip.html.
Fagon JY. Acute respiratory failure in the elderly. Crit Care. 2006;10(4):151.
Ray P, Birolleau S, Lefort Y, Becquemin MH, Beigelman C, Isnard R, Teixeira A, Arthaud M, Riou B, Boddaert J. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care. 2006;10(3):R82. Epub 2006 May 24.
Dardaine V, Constans T, Lasfargues G, Perrotin D, Giniès G. Outcome of elderly patients requiring ventilatory support in intensive care. Aging (Milano). 1995;7(4):221–7.
Dardaine V, Dequin PF, Ripault H, Constans T, Giniès G. Outcome of older patients requiring ventilatory support in intensive care: impact of nutritional status. J Am Geriatr Soc. 2001;49(5):564–70.
Cox CE, Carson SS, Lindquist JH, Olsen MK, Govert JA, Chelluri L, Quality of Life After Mechanical Ventilation in the Aged (QOL-MV) Investigators. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care. 2007;11(1):R9.
Lieberman D, Nachshon L, Miloslavsky O, Dvorkin V, Shimoni A, Lieberman D. How do older ventilated patients fare? A survival/functional analysis of 641 ventilations. J Crit Care. 2009;24(3):340–6. doi:10.1016/j.jcrc.2009.01.015.
Tang EY, Hsu LF, Lam KN, Pang WS. Critically ill elderly who require mechanical ventilation: the effects of age on survival outcomes and resource utilisation in the medical intensive care unit of a general hospital. Ann Acad Med Singapore. 2003;32(5):691–6.
Schortgen F, Follin A, Piccari L, Roche-Campo F, Carteaux G, Taillandier-Heriche E, Krypciak S, Thille AW, Paillaud E, Brochard L. Results of noninvasive ventilation in very old patients. Ann Intensive Care. 2012;2(1):5. doi:10.1186/2110-5820-2-5.
Riario-Sforza GG, Scarpazza P, Incorvaia C, Casali W. Role of noninvasive ventilation in elderly patients with hypercapnic respiratory failure. Clin Ter. 2012;163(1):e47–52.
Guerra C, Linde-Zwirble WT, Wunsch H. Risk factors for dementia after critical illness in elderly medicare beneficiaries. Crit Care. 2012;16(6):R233.
Martindale RG, McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G, American College of Critical Care Medicine; A.S.P.E.N. Board of Directors. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary. Crit Care Med. 2009;37(5):1757–61.
To KB, Napolitano LM. Common complications in the critically ill patient. Surg Clin North Am. 2012;92(6):1519–57. doi:10.1016/j.suc.2012.08.018.
http://www.shea-online.org/HAITopics/CompendiumofStrategiestoPreventHAIs.aspx.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Tarras, S.L., Napolitano, L.M. (2014). Critical Care Epidemiology and Outcomes/Resource Use in the Elderly. In: Yelon, J., Luchette, F. (eds) Geriatric Trauma and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8501-8_29
Download citation
DOI: https://doi.org/10.1007/978-1-4614-8501-8_29
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-8500-1
Online ISBN: 978-1-4614-8501-8
eBook Packages: MedicineMedicine (R0)