Senior Citizens Who Survive ICU Stay Have High Rate
of Death in Following Three Years
Elderly who receive mechanical ventilation have
substantially increased rate of death in first several months after
hospital discharge compared with hospital and general population groups
March 2, 2010 - Senior citizen patients who are
hospitalized in an intensive care unit (ICU) and survive to be
discharged from the hospital have a high rate of death in the following
three years, according to a study in the March 3 issue of the Journal
of the American Medical Association (JAMA).
People who survive to 70 in reasonable health have
different set of risks and benefits associated with the amount of body
fat to younger people; study questions current BMI guidelines for older
adults
There
could be an overall colorectal cancer mortality reduction of 50 percent
by 2020; rates declined most among senior citizens over 65 and increased
most in people under age 50
Reviving a pulse beat at the scene is best
chance of survival; dismal trend considering enormous spending on heart
research, new emergency care protocols, new drugs, devices such as
defibrillators
This analysis of Medicare data also found that
elderly patients who receive mechanical ventilation have a substantially
increased rate of death compared with both hospital and general
population groups in the first several months after hospital discharge.
Although there has been a decrease over time in the
risk of in-hospital death for patients who receive intensive care in the
United States, little has known about subsequent outcomes for those
discharged alive.
"Patients older than 65 years now make up more than
half of all ICU admissions," the authors write. Information is needed to
understand the patterns of mortality, morbidity, and health care
resource use in the months and years that follow critical illness to
allow for better targeting of follow-up care."
The 3-year outcomes and health care resource use of
ICU survivors, and identified subgroups of patients and periods in which
patients are at highest risk of death, using a 5 percent sample of
Medicare beneficiaries older than 65 years, were examined by Hannah
Wunsch, M.D., M.Sc., of Columbia University Medical Center and NewYork-Presbyterian
Hospital/Columbia, New York, and colleagues.
A random half of all patients were selected who
received intensive care and survived to hospital discharge in 2003 with
3-year follow-up through 2006.
From the other half of the sample, 2 matched
control groups were generated: hospitalized patients who survived to
discharge (hospital controls) and the general population (general
controls), individually matched on age, sex, race, and whether they had
surgery (for hospital controls).
In the data analyzed for the study, 35,308 ICU
patients survived to hospital discharge. The ICU survivors had a higher
3-year mortality (39.5 percent) than hospital controls (34.5 percent)
and general controls (14.9 percent.
The ICU survivors who did not receive mechanical
ventilation had minimal increased risk compared with hospital controls
(3-year mortality, 38.3 percent vs. 34.6 percent).
"However, mortality for those who received
mechanical ventilation was substantially higher than for the
corresponding hospital controls (3-year mortality: 57.6 percent vs. 32.8
percent, respectively). This difference was primarily due to mortality
during the first 2 quarters following hospital discharge (6-month
mortality: 30.1 percent for ICU survivors vs. 9.6 percent for hospital
controls)," the authors write.
Discharge to a skilled care facility for ICU
survivors (33.0 percent) and hospital controls (26.4 percent) also was
associated with high 6-month mortality (24.1 percent for ICU survivors
and hospital controls discharged to a skilled care facility vs. 7.5
percent for ICU survivors and hospital controls discharged home).
"The magnitude of the post-discharge use of skilled
care facilities for both ICU survivors and hospital controls and the
high long-term mortality for all of these patients call into question
whether discharge to skilled care facilities is merely a marker for
higher severity of illness with appropriate delivery of care.
These patients could have been discharged
prematurely from acute care hospitals, and needed a higher level of care
than they received. It also is possible that these patients could have
had better outcomes if discharged home, but were not able to be sent
there due to lack of sufficient support from family or friends to act as
caregivers.
These findings highlight the need for a much more
detailed understanding of the long-term care needs of these patients,"
the authors conclude.
Keep up with the latest news for senior citizens, baby
boomers
March 2, 2010 - Senior citizen patients who are
hospitalized in an intensive care unit (ICU) and survive to be
discharged from the hospital have a high rate of death in the following
three years, according to a study in the March 3 issue of the Journal
of the American Medical Association (JAMA).
