Short-term outcomes in older intensive care unit patients with dementia.
OBJECTIVE
To determine the impact of dementia on the outcomes of intensive care unit (ICU) care and use of ICU interventions among older patients.


METHODS
Prospective observational cohort study.


METHODS
Urban university teaching hospital.


METHODS
Patients were 395 patients age >/=65 consecutively admitted to a medical ICU.


METHODS
None.


RESULTS
Dementia was determined by a previously validated proxy measure, the Modified Blessed Dementia Rating Scale. We chose cut points to focus on patients with moderate-severe dementia at baseline. Our primary outcomes included length of mechanical ventilation and ICU and hospital length of stay. Secondary outcomes included ICU readmission, changes in code status, discharge location, mortality, and use of ICU interventions. Medical record abstraction was performed to determine the rates of ICU outcomes, use of ICU interventions, and potential confounders. Our study documented a prevalence of moderate-severe dementia of 17% in patients age >/=65 admitted to the ICU. Patients with dementia were significantly older (80 vs. 76), more likely to be female (65% vs. 52%), and more likely to be admitted from a nursing home (46% vs. 11%). Patients with dementia had significantly higher Acute Physiology and Chronic Health Evaluation II scores on admission to the ICU (25 vs. 23). Patients with dementia were more likely to have their code status changed to less aggressive in the ICU (24% vs. 14%). There was no significant difference in readmission to the ICU, discharge location, ICU or hospital mortality rate, or use of ICU interventions between patients with and without dementia.


CONCLUSIONS
Our study documents no difference in outcomes from ICU care in older patients with and without dementia. There was no increased short-term mortality rate in older patients with dementia compared with those without dementia after admission to the ICU. Presumptions that outcomes from critical care are less favorable in patients with dementia should not drive treatment decisions in the ICU.
Pisani
Margaret A
MA
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8057, USA. Margaret.Pisani@yale.edu
Redlich
Carrie A
CA
McNicoll
Lynn
L
Ely
E Wesley
EW
Friedkin
Rebecca J
RJ
Inouye
Sharon K
SK
D000368:Aged; D000369:Aged, 80 and over; D003237:Connecticut / Q000453:epidemiology; D003422:Critical Care / Q000706:statistics & numerical data; D003704:Dementia; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016896:Treatment Outcome