Hospital discharge to care facility: a patient-centered outcome for the evaluation of intensive care for octogenarians

Abstract

Introduction: Hospital survival and length of stay are commonly used for the evaluation of intensive care outcome for the young and octogenarian patients (>/= 80 years old).

Hypothesis: Hospital discharge to a care facility should be considered for more accurate evaluation of intensive care outcome, especially for octogenarian patients.

Design: An observational descriptive study.

Patients: A total of 6,154 consecutive hospital admissions requiring intensive care over 4 years.

Measurements: Demographics, preadmission comorbidities, severity of illness, acute hospital diagnosis categories, charges and destination after discharge, and postdischarge survival for up to 42 months.

Results: Octogenarians represented 15% of intensive care admissions (900 admissions). The interventions performed in the ICU, the severity of illness measured by sequential organ failure assessment (SOFA), and hospital length of stay were similar for octogenarian and younger patients. Octogenarians had higher hospital mortality (10% vs 6%, p < 0.01) and discharge to care facility (35% vs 18%, p < 0.01) than younger patients. The average hospital charge per octogenarian hospital survivor discharged to home was $128,000, compared to $100,000 for a younger hospital survivor. At follow-up, octogenarian hospital survivors who were discharged to a care facility had higher mortality than hospital survivors discharged to home (31% vs 17%, p < 0.01). On multiple logistic regression, older age, female gender, preadmission comorbidities, type of admission, SOFA score >/= 4, mechanical ventilation >/= 96 h, requirement for tracheotomy, and hospital diagnosis categories were independent factors for discharge of hospital survivors to a care facility.

Conclusions: Hospital survival and length of stay did not accurately measure intensive care outcome for octogenarians. Care dependency among octogenarians who survived intensive care was prevalent and decreased their long-term survival. Care dependency and functional disability among hospital survivors should be considered for more accurate evaluation of intensive care outcome in that age group.