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

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Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015
Chest ( IF 9.5 ) Pub Date : 2022-01-11 , DOI: 10.1016/j.chest.2021.12.658
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

Affiliation

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.

中文翻译：

1998 年至 2015 年间入住美国 ICU 的老年人的老年疾病趋势

背景

越来越多的老年人入住 ICU，而那些有残疾、痴呆、虚弱和合并多种疾病的人很容易受到不良后果的影响。关于先前存在的老年病症如何随时间发生变化知之甚少。

研究问题

从 1998 年到 2015 年，入住 ICU 的老年人在残疾、痴呆、虚弱和合并症方面有何变化？

研究设计和方法

与医疗保险相关的健康和退休调查 (HRS) 数据确定了 1998 年至 2015 年间入住 ICU 的 65 岁及以上患者。ICU 入住是分析单位。进入 ICU 的年份是曝光率。根据入住 ICU 前对 HRS 调查的反应，确定了残疾、痴呆、虚弱和多种疾病。残疾表示需要协助进行≥ 1 项日常生活活动。痴呆症使用认知和功能措施。虚弱包括 ≥ 2 个领域（身体、营养、认知或感觉功能）的缺陷。多重病态代表 ≥ 3 种自我报告的慢性疾病。老年病的时间趋势被建模为 ICU 入院年份的函数，并根据年龄、性别、种族或民族以及代理面谈状态进行了调整。

结果

在 6,084 名 ICU 患者中，入院年龄从 1998 年的 77.6 岁（95% CI，76.7-78.4 岁）增加到 2015 年的 78.7 岁（95% CI，77.5-79.8 岁）（趋势 P <.001 ）。调整后因既往残疾而入住 ICU 的比例从 1998 年的 15.5% (95% CI, 12.1%-18.8%) 上升到 2015 年的 24.0% (95% CI, 18.5%-29.6%) (P = .001 ) . 痴呆症的发生率没有显着变化 ( P = .21)。虚弱从 1998 年的 36.6% (95% CI, 30.9%-42.3%) 增加到 2015 年的 45.0% (95% CI, 39.7%-50.2%) (P = .04 ) ；多发病率从 1998 年的 54.4% (95% CI, 49.2%-59.7%) 上升到 2015 年的 71.8% (95% CI, 66.3%-77.2%) (P < .001 ) 。