Predictors of Mortality in Older Patients following Medical Intensive Care: The Importance of Functional Status

Objective: We examined predictors of hospital and 6‐month mortality in older Medical Intensive Care Unit (MICU) patients with particular attention to age and functional status. Age is generally thought to be strongly associated with intensive care outcomes, but this relationship may be confounded by age‐related changes. These age‐related changes may be approximated by changes in functional status (FS).

[1]  W. Sage,et al.  Is intensive care worth it? An assessment of input and outcome for the critically ill. , 1986 .

[2]  Predicting mortality of intensive care unit patients. The importance of coma , 1982, Critical care medicine.

[3]  H. Rubin,et al.  Are Elderly People Less Responsive to Intensive Care? , 1990, Journal of the American Geriatrics Society.

[4]  D. Callahan,et al.  Rationing medical progress. The way to affordable health care. , 1990, The New England journal of medicine.

[5]  M. Moskowitz,et al.  Discharge decision-making in a medical intensive care unit. Identifying patients at high risk of unexpected death or unit readmission. , 1988, The American journal of medicine.

[6]  L. Rubenstein,et al.  Predictors of Immediate and 6‐Month Outcomes in Hospitalized Elderly Patients , 1988, Journal of the American Geriatrics Society.

[7]  D. Cullen,et al.  Results, charges, and benefits of intensive care for critically ill patients: Update 1983 , 1984, Critical care medicine.

[8]  A. J. Swinburne,et al.  Relationship of patient age to cost and survival in a medical ICU , 1983, Critical care medicine.

[9]  B. Zarén,et al.  Survival of intensive care patients I: prognostic factors from the patient's medical history , 1988, Acta anaesthesiologica Scandinavica.

[10]  A. J. Swinburne,et al.  Intensive Care for Elderly Patients with Myocardial Infarction: Age-related Comparison of Clinical Features and Outcome , 1988 .

[11]  W. Browner,et al.  Prognosis of non cardiac medical patients receiving mechanical ventilation in a veterans hospital , 1987 .

[12]  B. Zarén,et al.  Survival of intensive care patients II: outcome prediction 1 hour after admission , 1988, Acta anaesthesiologica Scandinavica.

[13]  R. L. Rosen,et al.  Long-term outcomes for elderly survivors of prolonged ventilator assistance. , 1989, Chest.

[14]  H. Horst,et al.  Factors influencing survival of elderly trauma patients , 1986, Critical care medicine.

[15]  J. Nunn,et al.  Survival of patients ventilated in an intensive therapy unit. , 1979, British medical journal.

[16]  D. Cullen,et al.  Survival, Hospitalization Charges and Follow-up Results in Critically Ill Patients , 1976 .

[17]  D. Cullen,et al.  Survival, hospitalization charges and follow-up results in critically ill patients. , 1976, New England Journal of Medicine.

[18]  W. Sage,et al.  Intensive Care for the Elderly: Outcome of Elective and Nonelective Admissions , 1987, Journal of the American Geriatrics Society.

[19]  J. L. Gall,et al.  Influence of age, previous health status, and severity of acute illness on outcome from intensive care , 1982, Critical care medicine.

[20]  N. Jecker,et al.  Ethical Constraints on Rationing Medical Care by Age , 1989, Journal of the American Geriatrics Society.

[21]  D. Callahan Terminating treatment: age as a standard. , 1987, The Hastings Center report.

[22]  Assessing illness severity and outcome in critically ill patients. , 1986, Emergency medicine clinics of North America.

[23]  T. Raffin,et al.  Intensive care unit survival of patients with systemic illness. , 1989, The American review of respiratory disease.

[24]  A. Relman Is rationing inevitable? , 1990, The New England journal of medicine.

[25]  V. Zagonel,et al.  Age as a risk factor for inadequate treatment. , 1988, JAMA.

[26]  R. Veatch Justice and the economics of terminal illness. , 1988, The Hastings Center report.

[27]  W. Knaus,et al.  APACHE II: a severity of disease classification system. , 1985 .

[28]  D. McClish,et al.  The Impact of Age on Utilization of Intensive Care Resources , 1987, Journal of the American Geriatrics Society.

[29]  J. Civetta,et al.  Therapeutic intervention scoring system: a method for quantitative comparison of patient care. , 1974, Critical care medicine.

[30]  W. Sage,et al.  Is intensive care worth it?–An assessment of input and outcome for the critically ill , 1986, Critical care medicine.

[31]  E. Skinner,et al.  Functional outcomes following medical intensive care , 1986, Critical care medicine.

[32]  W. Browner,et al.  Prognosis of noncardiac medical patients receiving mechanical ventilation in a veterans hospital. , 1988, The American journal of medicine.

[33]  G O Barnett,et al.  Medical intensive care: indications, interventions, and outcomes. , 1980, The New England journal of medicine.

[34]  G. Barnett,et al.  Medical intensive care for the elderly. A study of current use, costs, and outcomes. , 1981, JAMA.

[35]  R. Brook,et al.  The early effect of Medicare's prospective payment system on the use of medical intensive care services in three community hospitals. , 1988, JAMA.

[36]  K. Norberg,et al.  Intensive care of the elderly ‐ a retrospective study , 1986, Acta anaesthesiologica Scandinavica.

[37]  S. Lemeshow,et al.  Two-Year Outcome of Adult Intensive Care Patients , 1984, Medical care.

[38]  B. Zarén,et al.  Survival compared to the general population and changes in health status among intensive care patients , 1989, Acta anaesthesiologica Scandinavica.

[39]  H Pastides,et al.  A method for predicting survival and mortality of ICU patients using objectively derived weights , 1985, Critical care medicine.

[40]  A. Mulley,et al.  Nursing Home Patients Admitted to a Medical Intensive Care Unit , 1984, Medical care.

[41]  D. E. Lawrence,et al.  APACHE—acute physiology and chronic health evaluation: a physiologically based classification system , 1981, Critical care medicine.

[42]  R. Byrick,et al.  Outcome of respiratory intensive care for the elderly , 1985, Critical care medicine.

[43]  J. Kilner Age criteria in medicine. Are the medical justifications ethical? , 1989, Archives of internal medicine.

[44]  N. Levinsky Age as a criterion for rationing health care. , 1990, The New England journal of medicine.

[45]  M. Madsen,et al.  Outcome from intensive care. II. A 5-year study of 1308 patients: short-term outcome. , 1989, European journal of anaesthesiology.

[46]  M. Chassin Costs and Outcomes of Medical Intensive Care , 1982, Medical care.