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. 2022 Jun;161(6):1555-1565.
doi: 10.1016/j.chest.2021.12.658. Epub 2022 Jan 11.

Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015

Julien Cobert  1 , Sun Young Jeon  2 , John Boscardin  3 , Allyson C Chapman  4 , Lauren E Ferrante  5 , Sei Lee  2 , Alexander K Smith  2
Affiliations

Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015

Julien Cobert et al. Chest. 2022 Jun.

Abstract

Background: Older adults are increasingly admitted to the ICU, and those with disabilities, dementia, frailty, and multimorbidity are vulnerable to adverse outcomes. Little is known about how pre-existing geriatric conditions have changed over time.

Research question: How have changes in disability, dementia, frailty, and multimorbidity in older adults admitted to the ICU changed from 1998 through 2015?

Study design and methods: Medicare-linked Health and Retirement Survey (HRS) data identifying patients 65 years of age and older admitted to an ICU between 1998 and 2015. ICU admission was the unit of analysis. Year of ICU admission was the exposure. Disability, dementia, frailty, and multimorbidity were identified based on responses to HRS surveys before ICU admission. Disability represented the need for assistance with ≥ 1 activity of daily living. Dementia used cognitive and functional measures. Frailty included deficits in ≥ 2 domains (physical, nutritive, cognitive, or sensory function). Multimorbidity represented ≥ 3 self-reported chronic diseases. Time trends in geriatric conditions were modeled as a function of year of ICU admission and were adjusted for age, sex, race or ethnicity, and proxy interview status.

Results: Across 6,084 ICU patients, age at admission increased from 77.6 years (95% CI, 76.7-78.4 years) in 1998 to 78.7 years (95% CI, 77.5-79.8 years) in 2015 (P < .001 for trend). The adjusted proportion of ICU admissions with pre-existing disability rose from 15.5% (95% CI, 12.1%-18.8%) in 1998 to 24.0% (95% CI, 18.5%-29.6%) in 2015 (P = .001). Rates of dementia did not change significantly (P = .21). Frailty increased from 36.6% (95% CI, 30.9%-42.3%) in 1998 to 45.0% (95% CI, 39.7%-50.2%) in 2015 (P = .04); multimorbidity rose from 54.4% (95% CI, 49.2%-59.7%) in 1998 to 71.8% (95% CI, 66.3%-77.2%) in 2015 (P < .001).

Interpretation: Rates of pre-existing disability, frailty, and multimorbidity in older adults admitted to ICUs increased over time. Geriatric principles need to be deeply integrated into the ICU setting.

Keywords: dementia; disability; epidemiology; frailty; geriatrics.

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Figures

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Graphical abstract
Figure 1
Figure 1
A-D, Line graphs showing adjusted rates of ADL dependence (A), dementia (Wu-Glymour) (B), frailty (C), and multimorbidity (D) in older adults admitted to the ICU. Trends in ADL dependence, frailty and multimorbidity are statistically significant, with P values shown above. Dementia trend showed a P value of > .05 and was deemed not statistically significant. All trends were adjusted for age, sex, race, ethnicity, and proxy interview status and were weighted to account for the complex survey design of the Health and Retirement Study. Dementia was defined using the Wu-Glymour criteria for dementia. Multimorbidity was defined as having three or more self-reported chronic diseases. Horizontal lines represent 0.10 or 10% increments. ADL = activity of daily living.
Figure 2
Figure 2
Line graph showing adjusted dependence in individual ADLs in older adults admitted to the ICU. Trends for dressing (P = .004), walking (P < .001), eating (P = .01), toileting (P = .03), and transferring (P = .007) all were deemed statistically significant. Trend for bathing (P = .06) was deemed statistically nonsignificant. Trends were adjusted and weighted to account for the complex survey design of the Health and Retirement Study. Horizontal lines represent 0.10 or 10% increments. ADL = activity of daily living.
Figure 3
Figure 3
A-C, Line graphs showing adjusted rates of fair or poor hearing (A); fair, poor, or blind vision (B), and difficulty lifting 10 pounds (C) in older adults admitted to the ICU. Trend for fair or poor hearing had a P value of .71 and fair, poor, or blind vision had a P value of .75 and were deemed not statistically significant. Trend for difficulty lifting 10 pounds had a P value of .06 and was deemed not statistically significant. All trends were adjusted for age, sex, race, ethnicity, and proxy interview status and were weighted to account for the complex survey design of the Health and Retirement Study. Horizontal lines represent 0.10 or 10% increments.
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