Functional outcome in intensive care older survivors
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ORIGINAL ARTICLE
Functional outcome in intensive care older survivors Safaa Hussein Ali1 · Remon Asaad Nasr2 · Rania Mohammed Abou‑Hashem1 Received: 20 March 2020 / Accepted: 6 August 2020 © Springer Nature Switzerland AG 2020
Abstract Background Most of the research focused on mortality and neglected functional outcome in older patients admitted to intensive care unit (ICU). Aims The aim of this study is evaluating functional outcome in older patients admitted to ICU. Methods A cross-sectional study of 203 elderly patients admitted to Geriatric ICU in Ain Shams University Hospitals and followed for 90 days after ICU discharge to track their functional level and other adverse outcomes. Results The mean age for the cohort was 72.6 ± 8.8. Seventy-three patients survived after 3 months (36%). Only 42 patients out of 73 survivors maintained the same level of functions (58%). Factors related to functional decline were Charlson Comorbidity Index and infections acquired within 3 months after discharge. ICU scores, like APACHE and SAPS II scores were not effective in predicting functional outcomes. Conclusions Comorbidity burden and infections acquired within 3 months after discharge are important determinants of long-term functional level after ICU admission. Keywords Function · Older patients · Intensive care · Adverse outcome · Infections-survivors
Introduction Older patients represent a substantial sector of intensive care unit (ICU) patients. Increased survival and comorbidities lead to an increase in ICU admission [1]. Once admitted, intensivists apply their scores upon older patients trying to predict the mortality rate. However, they forget that mortality, though important, does not represent the entire importance in their life. Being independent and keeping autonomy should be of paramount significance in older patient outcome measures. Most of the studies searched the factors that can predict ICU mortality [2–4]. While others concentrated on longterm survival [5, 6]. Other studies focused on the outcome of older patients after ICU. However, they have been restricted mainly to * Rania Mohammed Abou‑Hashem [email protected]; [email protected] 1
Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Anaesthesia and Pain Management Department, EL Matarya Teaching Hospital, Cairo, Egypt
2
surgical patients [7, 8]. Results were heterogeneous with regard to functional outcome. One study observed that most of the patients that were independent for ADL (Activities of Daily Living) prior to ICU entry sustained this situation 1 year later [9]. On the contrary, another study revealed increased dependence in some ADL several months after ICU discharge [10]. While another study found no differences in ADL before and after ICU stay [11]. Generally, functional status is not assessed well at admission or as an endpoint after discharge. It is observed that many ICU prediction scores, like APACHE II and SAPS II, were done to predict mortality rather t
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