Factors that predict outcome of intensive care treatment in very elderly patients: a review.
BACKGROUND
Advanced age is thought to be associated with increased mortality in critically ill patients. This report reviews available data on factors that determine outcome, on the value of prognostic models, and on preferences regarding life-sustaining treatments in (very) elderly intensive care unit (ICU) patients.


METHODS
We searched the Medline database (January 1966 to January 2005) for English language articles. Selected articles were cross-checked for other relevant publications.


RESULTS
Mortality rates are higher in elderly ICU patients than in younger patients. However, it is not age per se but associated factors, such as severity of illness and premorbid functional status, that appear to be responsible for the poorer prognosis. Patients' preferences regarding life-sustaining treatments are importantly influenced by the likelihood of a beneficial outcome. Commonly used prognostic models have not been calibrated for use in the very elderly. Furthermore, they do not address long-term survival and functional outcome.


CONCLUSIONS
We advocate the development of new prognostic models, validated in elderly ICU patients, that predict not only survival but also functional and cognitive status after discharge. Such a model may support informed decision making with respect to patients' preferences.
de Rooij
Sophia E
SE
Department of Geriatrics, Academic Medical Center, University of Amsterdam, Amsterdam. s.e.derooij@amc.uva.nl
Abu-Hanna
Ameen
A
Levi
Marcel
M
de Jonge
Evert
E
D000203:Activities of Daily Living; D000367:Age Factors; D000369:Aged, 80 and over; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D003661:Decision Support Techniques; D016330:Frail Elderly / Q000706:statistics & numerical data*; D014943:Global Health; D017052:Hospital Mortality; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011379:Prognosis; D012307:Risk Factors