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

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 >or= 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 >or= 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 >or= 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 >or= 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.

Figure 1

Intensive care unit admissions for patients aged ≥ 80 years. Absolute number and proportion of intensive care unit admissions for patients aged ≥ 80 years from the Australian and New Zealand Intensive Care Society Adult Patient Database 2001 to 2005.

Figure 2

Severity of illness and outcomes for patients aged ≥ 80 years. Trends in severity of illness and outcomes for patients aged ≥ 80 years from the Australian and New Zealand Intensive Care Society Adult Patient Database 2001 to 2005. (a) Mean and standard deviation Acute Physiology and Chronic Health Evaluation (APACHE) II and nonage APACHE II scores. (b) Crude mortality with 95% confidence interval and adjusted odds ratio (OR) with 95% confidence interval for death.

Figure 3

Hospital mortality and intensive care unit (ICU) length of stay by age category from the Australian and New Zealand Intensive Care Society Adult Patient Database 2001 to 2005.

Figure 4

Discharge to rehabilitation or long-term care facility and intensive care unit (ICU) length of stay by age category from the Australian and New Zealand Intensive Care Society Adult Patient Database 2001 to 2005.

Figure 5

Projected intensive care unit and hospital estimations for patients aged ≥ 80 years. (a) Projected intensive care unit (ICU) admissions and (b) projected ICU and hospital bed-days for patients aged ≥ 80 years for Australia and New Zealand (ANZ) from 2006 to 2015. ANZICS APD, Australian and New Zealand Intensive Care Society Adult Patient Database.