Study shows need for geriatric principles in critical care medicine

There was an increased prevalence of geriatric conditions – meaning pre-existing disability, frailty and multimorbidity – in elderly patients admitted to the intensive care unit (ICU) between 1998 and 2015, according to the results. of a study published in the journal Chest.

Investigators in the current study sought to explore how changes in disability, dementia, frailty, and multimorbidity among older adults admitted to an intensive care unit changed from 1985 to 2015. These geriatric findings from interest were analyzed using data from a nationally representative survey of older adults. , the health and retirement study. Investigators identified survey respondents aged 65 and older who had been admitted to an intensive care unit during the study period. Disability was defined as the need for assistance with at least 1 activity of daily living. Dementia was assessed using cognitive and functional measures. Frailty included deficits in at least 2 domains (ie, physical, nutritional, cognitive, or sensory function). Multimorbidity denoted at least 3 self-reported chronic diseases.

Among a total of 6084 patients admitted to an intensive care unit, age at admission decreased from 77.6 years (95% CI, 76.7-78.4) in 1998 to 78.7 years ( 95% CI, 77.5-79.8) in 2015

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(P <.001 for trend the adjusted percentage of icu admissions with a pre-existing disability increased significantly from ci in to>P =.001). No significant changes were reported in dementia rates (P =.21). Frailty rates increased significantly from 36.6% (95% CI, 30.9-42.3%) in 1998 to 45.0% (95% CI, 39.7-50, 2%) in 2015 (P =.04). Additionally, multimorbidity increased significantly from 54.4% (95% CI, 49.2-59.7%) in 1998 to 71.8% (95% CI, 66.3-77.2 %) in 2015 (P <.001>

Heart disease was the most common reason for hospitalization and was also the most common primary diagnosis for any given hospitalization. The study cohort consisted of patients who self-identified as non-Hispanic or white (76.7%), non-Hispanic black (14.0%) and Hispanic (7.6%). Over all the years evaluated in the study, 61.4% of the patients had multimorbidity and 84.2% had at least 2 chronic diseases.

The researchers concluded that the results of the current study underscore the urgent need to incorporate geriatric principles into critical care medicine. Further research is warranted to examine whether early interventions that emphasize physical, cognitive, and mental health, prevention of delirium, advanced care planning, and rehabilitation, and that are individualized for critically ill older patients with of pre-existing geriatric conditions, may improve critical care outcomes in this population.

Disclosure: None of the study authors declared any affiliation with any biotechnology, pharmaceutical and/or device companies.


Cobert J, Jeon SY, Boscardin J, et al. Trends in geriatric conditions among older adults admitted to intensive care units in the United States between 1998 and 2015. Chest. Published online January 10, 2022. doi:10.1016/j.chest.2021.12.658

About Antoine L. Cassell

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