A recent study examines whether increased intensive care unit admissions reduce mortality in elderly patients.
The Intensive Care Unit (ICU) of a hospital is a unit that provides specialized care and intensive treatment to adult and geriatric critical care patients. It is accessible only to hospital staff, and there is a lower number of visiting hours to prevent the spread of infection to highly-ill patients. There has been a trend of seeing an increased level of critically severe individuals with an increase in age, leading to a high number of geriatric patients that require intensive care admission. However, a high mortality rate has been noticed with critically-ill elderly patients in France, directing concerns regarding the advantages of admission into an intensive care unit for the geriatric population.
These concerns led researchers in France to look for different methods by which they could decrease the number of ICU deaths. Researchers Guidet and colleagues made a temporary plan for systematic ICU admission. They conducted a study to evaluate if their new plan would reduce mortality in older patients by six months compared to the conventional practices for ICU at the hospital. The researchers performed this comparative study at the emergency department of 24 hospitals in France. There were 3,037 participants randomly allocated into two treatment groups. One treatment group was the systematic ICU group, and the other was the regular ICU pattern group.
The criteria for including the participants into the study was that they had to be over 75 years of age and be cancer free. It was mandatory that they displayed normal functional status which was calculated based on a standard called the Index of Independence in Activities of Daily Living 4. In addition, their nutrition status was considered, and any person with loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite was ruled out. Participants were recruited between January 2012 and April 2015 and were followed up until November 2015. The study recorded either the death or the status of the patient at the end of six months. The researchers quantified the admission rate, the death of the patient within the hospital, the functional position of the patient, and the quality of life the patient was leading.
The results of this first, randomized trial of ICU triage in elderly patients were not positive in this case. The patients who were admitted according to the systematic study group had an increased risk of in-hospital death and no reduction of risk of death at the end of six months despite an increased ICU admission. The researchers also noted that the functional status and physical quality of life did not alter much for these patients at the end of six months. Even though the program initiated by Guidet increased the use of the ICU, it didn’t do much to reduce the mortality of geriatric patients. These results were recently published in the Journal of the American Medical Association.
Although the results turned out to be negative, this study had many strengths. This study indicates that systematic intensive care unit admissions are not the solution to improving care for the elderly. The results in this study are a stepping stone in the direction of other research and changes in management plans, in order to understand and improve the admission of geriatric patients in the intensive care unit.
Written by Dr. Apollina Sharma, MBBS, GradDip EXMD
Reference: Guidet, B., Leblanc, G., Simon, T., Woimant, M., Quenot, J. P., Ganansia, O., … & Fartoukh, M. (2017). Effect of systematic intensive care unit triage on long-term mortality among critically ill elderly patients in France: a randomized clinical trial. JAMA.