Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade.
OBJECTIVE
Data collected from two cohorts of patients aged > or =80 yrs and admitted to an intensive care unit in France were compared to determine whether intensive care unit care and survival had evolved from the 1990s to the 2000s.


METHODS
Retrospective cohort study on patient data attained during intensive care unit stays.


METHODS
18-bed intensive care unit in an academic medical center.


METHODS
Two cohorts of patients aged > or =80 yrs, admitted to an intensive care unit at a 10-yr interval.


METHODS
None.


RESULTS
The first cohort comprised 348 patients admitted between January 1992 and December 1995, and the second cohort, 373 patients admitted between January 2001 and December 2004. There was no difference in age between the two cohorts, but patients in the second had significantly less history of functional limitation and significantly more acute illness (Simplified Acute Physiology Score II 43 +/- 18 vs. 57 +/- 25, respectively, p < .0001). Patients in the second cohort had a significantly higher Omega Score, had a higher occurrence of renal replacement therapy, and received vasopressors more frequently than the patients in the first cohort, even when adjusted for age, sex, Knaus classification, Simplified Acute Physiology Score II, and intensive care unit admission cause. Intensive care unit mortality was 65% and 64% for the first and second cohorts, respectively. In multivariate analysis (including age, Knaus classification, Simplified Acute Physiology Score II and first vs. second period) for association with intensive care unit survival, the 2001-2004 period was associated with a near tripling of chances of survival (odds ratio 2.9; 95% confidence interval, 1.92-4.47, p < .0001).


CONCLUSIONS
The characteristics and intensity of treatment for elderly people admitted to the intensive care unit changed significantly over a decade. The intensity of treatments has increased over time and survival has improved over time as well. A potential link between increased treatment and improved survival in the elderly may be evoked.
Lerolle
Nicolas
N
Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France. nicolas.lerolle@egp.aphp.fr
Trinquart
Ludovic
L
Bornstain
Caroline
C
Tadié
Jean-Marc
JM
Imbert
Audrey
A
Diehl
Jean-Luc
JL
Fagon
Jean-Yves
JY
Guérot
Emmanuel
E
D000367:Age Factors; D000369:Aged, 80 and over; D002423:Cause of Death; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003422:Critical Care / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome