Skip to main content
SpringerLink
Log in

How to Improve Care for Older Patients in the Intensive Care Unit

  • Chapter
  • First Online:
Acute Care for Elders

Part of the book series: Aging Medicine ((AGME))

  • 1167 Accesses

Abstract

A large proportion of hospital days are spent in the intensive care unit (ICU). Growing numbers of this critically ill patient population are elderly, and have baseline vulnerabilities putting them at an increased risk of having poor short- and long-term outcomes. Use of interdisciplinary collaboration in the care of elderly ICU patients is of utmost importance. This chapter reviews the unique needs of elderly ICU patients, methods for applying interdisciplinary Acute Care for Elders (ACE) interventions into ICU practice, and specific nursing considerations for elder care in the ICU. The chapter also reviews end-of-life needs and strategies for improved transitions of care for critically ill elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ICU:

Intensive Care Unit

ACE:

Acute Care for Elders

ADL:

Activities of daily living

SAT:

Spontaneous Awakening Trial

SBT:

Spontaneous Breathing Trial

CAM-ICU:

Confusion Assessment Method for the Intensive Care Unit

ICDSC:

Intensive Care Delirium Screening Checklist

References

  1. Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010;38(1):65–71. Epub 2009/09/05.

    Article  PubMed  Google Scholar 

  2. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich Jr J. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284(21):2762–70.

    Article  CAS  PubMed  Google Scholar 

  3. Vasilevskis EE, Ely EW, Speroff T, Pun BT, Boehm L, Dittus RS. Reducing iatrogenic risks: ICU-acquired delirium and weakness–crossing the quality chasm. Chest. 2010;138(5):1224–33. Epub 2010/11/06.

    Article  PubMed  Google Scholar 

  4. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306–16. Epub 2013/10/03.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Ehlenbach WJ, Hough CL, Crane PK, Haneuse SJ, Carson SS, Curtis JR, et al. Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA. 2010;303(8):763–70. Epub 2010/02/25.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme Jr JF. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005;171(4):340–7. Epub 2004/11/16.

    Article  PubMed  Google Scholar 

  7. Mehta KM, Yaffe K, Covinsky KE. Cognitive impairment, depressive symptoms, and functional decline in older people. J Am Geriatr Soc. 2002;50(6):1045–50. Epub 2002/07/12.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Balas MC, Casey CM, Happ MB. Geriatric nursing protocol: comprehensive assessment and management of the critically ill. Hartford Institute for Geriatric Nursing. http://consultgerirn.org.consultgerirn.org/. Last updated July 2012.

  9. Glisky EL. Changes in cognitive function in human aging. In: Riddle DR, editor. Brain aging: models, methods, and mechanisms. Boca Raton (FL): CRC Press; 2007. Chapter 1; Available from: http://www.ncbi.nlm.nih.gov/books/NBK3885/.

    Google Scholar 

  10. Pisani MA, Redlich C, McNicoll L, Ely EW, Inouye SK. Underrecognition of preexisting cognitive impairment by physicians in older ICU patients. Chest. 2003;124(6):2267–74.

    Article  PubMed  Google Scholar 

  11. Ely EW, Girard TD, Shintani AK, Jackson JC, Gordon SM, Thomason JW, et al. Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit Care Med. 2007;35(1):112–7. Epub 2006/11/30.

    Article  CAS  PubMed  Google Scholar 

  12. Bradway C, Hirschman KB. Working with families of hospitalized older adults with dementia. Am J Nurs. 2008;10:52–60.

    Article  Google Scholar 

  13. Davidson JE, Powers K, Hedayat KM, et al. Clinical practice guidelines for support of the family in patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007;35:605–16.

    Article  PubMed  Google Scholar 

  14. Barnes DE, Palmer RM, Kresevic DM, et al. Acute care for elders units produced shorter hospital stays at lower cost while maintaining patients’ functional status. Health Aff. 2012;31(6):1227–36.

    Article  Google Scholar 

  15. Ten Have EC, Nap RE, Tulleken JE. Quality improvement of interdisciplinary rounds by leadership training based on essential quality indicators of the Interdisciplinary Rounds Assessment Scale. Intensive Care Med. 2013;39(10):1800–7. doi:10.1007/s00134-013-3002-0.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Casey CM, Balas MC. Use of protocols in older intensive care unit patients. Is standardization appropriate? AACN Adv Crit Care. 2011;22(2):150–60.

    Article  PubMed  Google Scholar 

  18. Society for Critical Care Medicine. Award winning ICU designs. How to build a better facility for patients and caregivers. 2013 edition. www.sccm.org/professional_resources/guidelines/table_of_contents/documents/ICU_design.pdf

    Google Scholar 

  19. Morandi A, Brummel NE, Ely EW. Sedation, delirium and mechanical ventilation: the ‘ABCDE’ approach. Curr Opin Crit Care. 2011;17(1):43–9.

    Article  PubMed  Google Scholar 

  20. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.

    Article  PubMed  Google Scholar 

  21. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371(9607):126–34.

    Article  PubMed  Google Scholar 

  22. Delirium. Diagnostic and statistical manual of mental disorders DSM-IV-TR. 4th ed. Arlington, VA.: American Psychiatric Association; 2000. http://www.psychiatryonline.com

  23. Pun BT, Ely EW. The importance of diagnosing and managing ICU delirium. Chest. 2007;132(2):624–36.

    Article  PubMed  Google Scholar 

  24. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139–45. Epub 2006/11/30.

    Article  PubMed  Google Scholar 

  25. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874–82. Epub 2009/05/19.

    Article  PubMed  Google Scholar 

  26. Balas M, Olsen K, Gannon D, Sisson J, Sullivan J, Stothert J, et al. Safety and efficacy of the ABCDE bundle in critically-ill patients receiving mechanical ventilation. Crit Care Med. 2012;40(12):1–328 [abstract 1].

    Google Scholar 

  27. Olsen K, Burke W, Peitz G, Gannon D, Stothert J, Jawa R, et al. The ABCDE bundle reduces the incidence of delirium in non-mechanically ventilated patients. Crit Care Med. 2012;40(12):1–328 [abstract 5].

    Google Scholar 

  28. Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536–42.

    Article  PubMed  Google Scholar 

  29. Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med. 2008;36(3):953–63.

    Article  PubMed  Google Scholar 

  30. Heyland DK, Barwich D, Pichora D, et al. Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med. 2013;173(9):778–87.

    Article  PubMed  Google Scholar 

  31. Chaboyer W, James H, Kendall M. Transitional care after the intensive care unit: current trends and future directions. Crit Care Nurse. 2005;25(3):16–28.

    PubMed  Google Scholar 

  32. Balas MC, Chaperon C, Sisson JH, et al. Transitions experienced by older survivors of critical care. J Gerontol Nurs. 2011;37(12):14–25.

    Article  PubMed  Google Scholar 

  33. Snow V, Beck D, Budnitz T, et al. Transition of care consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society of Academic Emergency Medicine. J Hosp Med. 2009;4(6):364–70.

    Article  PubMed  Google Scholar 

  34. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703–10.

    Article  CAS  PubMed  Google Scholar 

  35. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859–64.

    Article  CAS  PubMed  Google Scholar 

  36. Balas MC, Vasilevskis EE, Burke WJ, Boehm L, Pun BT, Olsen KM, et al. Critical care nurses’ role in implementing the “ABCDE bundle” into practice. Crit Care Nurse. 2012;32(2):35–8, 40–7

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, Vanderbilt University, 1880 Portway Road, Spring Hill, TN, 37174, USA

    Leanne Boehm M.S.N., R.N., A.C.N.S.-B.C.

  2. Pulmonary and Critical Care Medicine, Geriatric Research Education Clinical Center (GRECC) of the VA Tennessee Valley Healthcare System, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Suite 6100, Nashville, TN, 37232, USA

    E. Wesley Ely M.D., M.P.H.

  3. Vanderbilt University, School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, USA

    Lorraine Mion Ph.D., R.N., F.A.A.N. (Independence Foundation Professor of Nursing)

Authors
  1. Leanne Boehm M.S.N., R.N., A.C.N.S.-B.C.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Wesley Ely M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorraine Mion Ph.D., R.N., F.A.A.N.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leanne Boehm M.S.N., R.N., A.C.N.S.-B.C. .

Editor information

Editors and Affiliations

  1. Aurora Sinai Medical Center, Milwaukee, Wisconsin, USA

    Michael L. Malone

  2. Hunter College, New York, New York, USA

    Elizabeth A. Capezuti

  3. Eastern Virginia Medical School, Norfolk, Virginia, USA

    Robert M. Palmer

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Boehm, L., Ely, E.W., Mion, L. (2014). How to Improve Care for Older Patients in the Intensive Care Unit. In: Malone, M., Capezuti, E., Palmer, R. (eds) Acute Care for Elders. Aging Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1025-0_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1025-0_13

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-1024-3

  • Online ISBN: 978-1-4939-1025-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation