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Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis

Sean M Bagshaw12, Steve AR Webb34, Anthony Delaney5, Carol George6, David Pilcher7, Graeme K Hart1 and Rinaldo Bellomo8*

Author Affiliations

1 Department of Intensive Care, Austin Hospital, Studley Road, Heidelberg, VIC 3084, Australia

2 Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Walter C Mackenzie Centre, 8440-112 ST NW, Edmonton, Alberta T6G 2B7, Canada

3 Department of Intensive Care, Royal Perth Hospital, Wellington Street, Perth, WA 6000 Australia

4 School of Population Health, University of Western Australia, Crawly, Perth, WA 6009, Australia

5 Intensive Therapy Unit, Royal North Shore Hospital, and Northern Clinical School, University of Sydney, St Leonards, Sydney, NSW 2065, Australia

6 Australia New Zealand Intensive Care Society (ANZICS) Clinical Outcomes and Resource Evaluation Centre, Carlton, 10 Ievers Terrace, VIC 3053, Australia

7 Department of Intensive Care Medicine, Alfred Hospital, Commercial Road, Prahran, VIC 3181, Australia

8 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia

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Critical Care 2009, 13:R45  doi:10.1186/cc7768


See related commentary by Frost and Fowler, http://ccforum.com/content/13/3/145

Published: 1 April 2009

Abstract

Introduction

Older age is associated with higher prevalence of chronic illness and functional impairment, contributing to an increased rate of hospitalization and admission to intensive care. The primary objective was to evaluate the rate, characteristics and outcomes of very old (age ≥ 80 years) patients admitted to intensive care units (ICUs).

Methods

Retrospective analysis of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data were obtained for 120,123 adult admissions for ≥ 24 hours across 57 ICUs from 1 January 2000 to 31 December 2005.

Results

A total of 15,640 very old patients (13.0%) were admitted during the study. These patients were more likely to be from a chronic care facility, had greater co-morbid illness, greater illness severity, and were less likely to receive mechanical ventilation. Crude ICU and hospital mortalities were higher (ICU: 12% vs. 8.2%, P < 0.001; hospital: 24.0% vs. 13%, P < 0.001). By multivariable analysis, age ≥ 80 years was associated with higher ICU and hospital death compared with younger age strata (ICU: odds ratio (OR) = 2.7, 95% confidence interval (CI) = 2.4 to 3.0; hospital: OR = 5.4, 95% CI = 4.9 to 5.9). Factors associated with lower survival included admission from a chronic care facility, co-morbid illness, nonsurgical admission, greater illness severity, mechanical ventilation, and longer stay in the ICU. Those aged ≥ 80 years were more likely to be discharged to rehabilitation/long-term care (12.3% vs. 4.9%, OR = 2.7, 95% CI = 2.6 to 2.9). The admission rates of very old patients increased by 5.6% per year. This potentially translates to a 72.4% increase in demand for ICU bed-days by 2015.

Conclusions

The proportion of patients aged ≥ 80 years admitted to intensive care in Australia and New Zealand is rapidly increasing. Although these patients have more co-morbid illness, are less likely to be discharged home, and have a greater mortality than younger patients, approximately 80% survive to hospital discharge. These data also imply a potential major increase in demand for ICU bed-days for very old patients within a decade.