Clinical characteristics and outcomes of critically ill elderly patients aged 90 years and older

Abstract

Demographic transition has led to a progressive increase in the proportion of elderly and very elderly patients. This population shift implies a growing demand for health resources, including intensive care, despite the high mortality rates associated with this age group in ICUs. To determine the clinical characteristics and outcomes of a population of critically ill elderly patients (≥ 90 years) admitted to the ICU and to identify predictive factors associated with mortality. This retrospective observational study analyzed data from critically ill elderly patients (≥ 90 years) admitted to the Intensive Medicine Service of a tertiary hospital in São Luís, MA, between 2021 and 2022. Demographic, clinical, treatment, and outcome data were collected, and statistical analysis was used to determine independent predictors of mortality. Of the 3551 patients admitted, 269 (≥ 90 years old) were included. The majority were female (69.5%), with a high prevalence of comorbidities. The emergency department was the main origin of patient admission (87%). The most frequent diagnostic category upon ICU admission was infection/sepsis. The median duration of ICU stay was seven days, and the median hospital stay was 15 days. The hospital mortality rate was 27.5%, and the ICU mortality rate was 17.8%. The use of mechanical ventilation and dialysis on the first day in the ICU was independently associated with increased mortality. Critically ill elderly patients (≥ 90 years) have a high prevalence of comorbidities, and specific interventions, such as mechanical ventilation and dialysis on the first day of the ICU, are predictors of mortality. Compared with other case series, the observed mortality was not high, suggesting that chronological age alone should not be a criterion for limiting access to intensive care. Decisions regarding triage (i.e., identifying which older adults are most likely to benefit from ICU-level care) and treatment limitations are crucial in this population.

Keywords: Comorbidities; Elderly; Frailty; Intensive care; Intensive care units; Very elderly.