Epidemiology of Elderly Patients Hospitalized in Intensive Care Unit for Severs Medical Illnesses
Science Journal of Public Health
Volume 1, Issue 5, November 2013, Pages: 215-221
Received: Oct. 9, 2013;
Published: Oct. 30, 2013
Views 2938 Downloads 97
Rhita Bennis Nechba, Department of Critical Care, El Idrissi Regional Hospital, Kenitra, Morocco; Laboratory of Genetic, Neuroendocrinology and Biothechnology, Ibn Tofaîl University, Kenitra
Moncif El M’barki Kadiri, Department of Nephrology, Dialysis and Transplantation, Military Hospital, Rabat, Morocco
Amine Ali Zeggwagh, Department of Medical Intensive Care, Ibn Sina University Hospital, Rabat, Morocco and Laboratory of Biostatistique, of Clinical Recherche and Epidemiology, Mohammed V University of Medicine and Pharmacy, Rabat, Morocco
Abdelhalim Mesfioui, Laboratory of Genetic, Neuroendocrinology and Biothechnology, Ibn Tofaîl University, Kenitra
Objectives: This study was made to identify the epidemiological data of elderly patients (over 65 years of age) vs. younger patients (< 65 years) requiring admission to the intensive care unit for severs medical illnesses. Design and patients: We conducted an analysis of a prospective observational study of 106 adults admitted to the intensive care unit for severs medical illnesses, from January 2010 to January 2012. Patients admitted to the intensive care unit for surgical illnesses were excluded. Setting: A 6-bed polyvalent intensive care unit in a regional hospital. Results: The study group included 31(29%) elderly patients (≥65 years of age) and 75 (71%) young patients (<65 years of age) (n=106). Elderly patients tended to have a higher simplified acute physiology score version II in admission (36 vs 21, p<0,001). There were several epidemiological differences between the two groups: Chronic diseases were more frequent in elderly patients than in younger one (diabetes (55% vs 20%; p<0,001), high blood pressure (45% vs 13%; p<0,001) and heart diseases (48% vs 19%; p=0,002). Elderly patients were significantly more hospitalized for delirium comparing to younger one (87% vs 64%; p=0,017), but dyspnea was less percepted by elderly patients 29% vs 55% for younger patients, p=0,016. Acute respiratory distress syndrome, acute heart failure, acute kidney injury, were all more frequent in elderly patients respectively (p= 0,006, p=0,014, p=0,005). The incidence of death was 37% for all patients and it was similar between the two groups (p=0,251). Conclusion: The identification of epidemiology of older patients hospitalized in intensive care unit for severs medical illnesses will help to develop qualified practice. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of complications.
Rhita Bennis Nechba,
Moncif El M’barki Kadiri,
Amine Ali Zeggwagh,
Epidemiology of Elderly Patients Hospitalized in Intensive Care Unit for Severs Medical Illnesses, Science Journal of Public Health.
Vol. 1, No. 5,
2013, pp. 215-221.
Teresita M. Hogan, MD, Eve D. Losman, MD, Christopher R. Carpenter, MD, Karen Sauvigne, MA, Cheryl Irmiter, PhD,Linda Emanuel, MD, PhD, and Rosanne M. Leipzig, MD. Development of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus Process. Acad Emerg Med. 2010; 17(3): 316–324.
Simon A. Geriatric patients in intensive care medicine. Ethical aspects. Med Klin Intensivmed Notfmed. 2011;106 (1):24-8.
Singler K, Christ M, Sieber C, Gosch M, Heppner HJ. Geriatric patients in emergency and intensive care medicine. Internist (Berl). 2011;52(8):934-8.
Le Gall JR, Lemeshow S, Saulnier F: A new Simplified Acute Physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993 ; 270:2957-63.
Neerland BE, Watne LO, Wyller TB. Delirium in elderly patients. Tidsskr Nor Laegeforen. 2013;133(15):1596-600.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2013 Aug 27. pii: S0140-6736(13)60688-1. doi: 10.1016/S0140-6736(13)60688-1. [Epub ahead of print]
Naeije G, Bachir I, Gaspard N, Legros B, Pepersack T. Epileptic activities are common in older people with delirium.Geriatr Gerontol Int. 2013 Aug 4. doi: 10.1111/ggi.12128. [Epub ahead of print]
Greffard S, Barrou Z, Godard M, Verny M. Epilepsy in the elderly. Rev Prat. 2011 ;61(10):1343-8.
Béjot Y, Rouaud O, Jacquin A, Osseby GV, Durier J, Manckoundia P, Pfitzenmeyer P, Moreau T, Giroud M. Stroke in the very old: incidence, risk factors, clinical features, outcomes and access to resources--a 22-year population-based study. Cerebrovasc Dis. 2010 ;29(2):111-21.
Ebihara S, Niu K, Ebihara T, Kuriyama S, Hozawa A, Ohmori-Matsuda K, Nakaya N, Nagatomi R, Arai H, Kohzuki M, Tsuji I. Impact of blunted perception of dyspnea on medical care use and expenditure, and mortality in elderly people. Front Physiol. 2012; 3:238.
Ardigo S, Perrenoud L, Philippe J. Diabetes in elderly: a tailored management. Rev Med Suisse. 2013; 9(389):1192-6, 1198-9.
Sinclair AJ, Robert IE, Croxson SC. Mortality in older people with diabetes mellitus. Diabet Med. 1997;14(8):639-47.
Corriere M, Rooparinesingh N, Kalyani RR. Epidemiology of Diabetes and Diabetes Complications in the Elderly: An Emerging Public Health Burden.Curr Diab Rep. 2013 Sep 11. [Epub ahead of print]
Schoenenberger AW, Erne P, Stuck AE. Hypertension in the elderly. Ther Umsch. 2012; 69(5):299-304.
Hanon O. Hypertension in the elderly: particularities and precautions. Presse Med. 2009; 38(4):614-20.
Frederique Schortgen, Arnaud Follin, Lucilla Piccari, Ferran Roche-Campo, Guillaume Carteaux, Elodie Taillandier-Heriche, Sebastien Krypciak, Arnaud W Thille, Elena Paillaud, and Laurent Brochard2,4,5 Results of noninvasive ventilation in very old patients. Ann Intensive Care. 2012; 2: 5
Nagase T. Respiratory failure Nihon Rinsho. 2013; 71(6):1031-4.
Falconnet C, Carballo S, Roffi M, Keller PF, Perrenoud JJ. Acute coronary syndrome: guidelines and geriatrics specificity. Rev Med Suisse. 2009; 5(204):1137-8, 1140-2, 1144-7.
Shanmugasundaram M, Alpert JS. Acute coronary syndrome in the elderly. Clin Cardiol. 2009; 32(11):608-13.
Belmin J, Chauvelier S, Friocourt P. Prevention of coronary heart disease and heart failure in the elderly. Rev Prat. 2009; 59(10):1389-95.
Nagase T. Respiratory failure. Nihon Rinsho. 2013; 71(6):1031-4.
Eachempati SR, Hydo LJ, Shou J, Barie PS. Outcomes of acute respiratory distress syndrome (ARDS) in elderly patients.J Trauma. 2007; 63(2):344-50.
Röhrig G, Doehner W, Schaefer RM, Schulz RJ. Anemia and iron deficiency in the elderly. Prevalence, diagnostics and new therapeutic options. Z Gerontol Geriatr. 2012 ; 45(3):191-6).
Astrid L Wester, 1 Oona Dunlop,2 Kjetil K Melby,3,4 Ulf R Dahle,1 and Torgeir Bruun Wyller3,5 Age-related differences in symptoms, diagnosis and prognosis of bacteremia. BMC Infect Dis. 2013; 13: 346.
Heppner HJ, Cornel S, Peter W, Philipp B, Katrin S. Infections in the elderly. Crit Care Clin. 2013; (3):757-74.
Pinheiro da Silva F, Zampieri FG, Barbeiro DF, Barbeiro HV, Goulart AC, Torggler Filho F, Velasco IT, da Cruz Neto LM, de Souza HP, Machado MC. Septic shock in older people: a prospective cohort study. Immun Ageing. 2013; 10(1):21. doi: 10.1186/1742-4933-10-21
Bourdel-Marchasson I, Kraus F, Pinganaud G, Texier-Maugein J, Rainfray M, Emeriau JP. Annual incidence and risk factors for nosocomial bacterial infections in an acute care geriatric unit. Rev Med Interne. 2001;22(11):1056-63.
Nasa P, Juneja D, Singh O, Dang R, Arora V. Severe sepsis and its impact on outcome in elderly and very elderly patients admitted in intensive care unit. J Intensive Care Med. 2012; 27(3):179-83.
Chami K, Gavazzi G, de Wazières B, Lejeune B, Carrat F, Piette F, Hajjar J, Rothan-Tondeur M. Guidelines for infection control in nursing homes: a Delphi consensus web-based survey. J Hosp Infect. 2011; 79(1):75-89.
Chami K, Gavazzi G, Carrat F, de Wazières B, Lejeune B, Piette F, Rothan-Tondeur M. Burden of infections among 44,869 elderly in nursing homes: a cross-sectional cluster nationwide survey. J Hosp Infect. 2011; 79(3):254-9.
Laurent M, Bories PN, Le Thuaut A, Liuu E, Ledudal K, Bastuji-Garin S, Paillaud E. Impact of comorbidities on hospital-acquired infections in a geriatric rehabilitation unit: prospective study of 252 patients. J Am Med Dir Assoc. 2012;13(8):760
Medve L, Csaba A, Paloczi B, Kocsi S, Gartner B, Marjanek Z et al. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study. BMC Nephrology 2011; 12:43.
Pisoni R, Wille KM, Tolwani AJ: The epidemiology of severe acute kidney injury: from BEST to PICARD, in acute kidney injury: new concepts. Nephron Clin Pract 2008 ; 109:188-91.
Silvester W, Bellomo R, Cole L: Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 2001 ; 29:1910-5.
Vincent JL: Incidence of acute renal failure in the intensive care unit. Contrib Nephrol 2001, 132:1-6.
Odutayo A, Adhikari NK, Barton J, Burns KE, Friedrich JO, Klein D et al. Epidemiology of acute kidney injury in Canadian critical care units: a prospective cohort study. Can J Anaesth. 2012 Jul 28. [Epub ahead of print]
De Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000; 26:915-21.
Kolhe NV, Stevens PE, Crowe AV, Lipkin GW, Harrison DA: Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care 2008; 12:S2.
Coca SG: Acute kidney injury in elderly persons. Am J Kidney Dis 2010; 56:122-31.
Himmelfarb J: Acute kidney injury in the elderly: problems and prospects. Semin Nephrol 2009; 29:658-64.
Wen J, Cheng Q, Zhao J, Ma Q, Song T, Liu S et al. Hospital-acquired acute kidney injury in Chinese very elderly persons. J Nephrol. 2012 May 28:0. doi: 10.5301/jn.5000182. [Epub ahead of print]
Zhou Q, Zhao C, Xie D, Xu D, Bin J,Chen P et al. Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: impact on outcomes. BMC Nephrology 2012; 13:51.
Koch A, Horn A, Dückers H, Yagmur E, Sanson E, Bruensing J, Buendgens L, Voigt S, Trautwein C, Tacke F. Increased liver stiffness denotes hepatic dysfunction and mortality risk in critically ill non-cirrhotic patients at a medical ICU. Crit Care. 2011;15(6):R266. doi: 10.1186/cc10543. Epub 2011 Nov 14.
Raurich JM, Llompart-Pou JA, Ferreruela M, Colomar A, Molina M, Royo C, Ayestarán I, Ibáñez J. Hypoxic hepatitis in critically ill patients: incidence, etiology and risk factors for mortality. J Anesth. 2011; 25(1):50-6.
Shawcross DL, Sharifi Y, Canavan JB, Yeoman AD, Abeles RD, Taylor NJ, Auzinger G, Bernal W, Wendon JA. Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis.J Hepatol. 2011; 54(4):640-9.
Joshua L, Devi P, Guido S. Adverse drug reactions in medical intensive care unit of a tertiary care hospital. Pharmacoepidemiol Drug Saf. 2009;18(7):639-45.
Lim SY, Jeon EJ, Kim HJ, Jeon K, Um SW, Koh WJ, Chung MP, Kim H, Kwon OJ, Suh GY. The incidence, causes, and prognostic significance of new-onset thrombocytopenia in intensive care units: a prospective cohort study in a Korean hospital. J Korean Med Sci. 2012; 27(11):1418-23.
RK Mani, P Amin, R Chawla, JV Divatia, F Kapadia, P Khilnani, SN Myatra, S Prayag, R Rajagopalan, SK Todi, R Uttam. Guidelines for end-of-life and palliative care in Indian intensive care units' ISCCM consensus Ethical Position Statement.Indien journal of critical care medicine.2012; 3 (16):166-81.
Vosylius S, Sipylaite J, Ivaskevicius J. Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing 2005;34:157-162.
Sacanella E, Pe´rez-Castejo´n JM, Nicola´s JM, et al. Mortality in healthy elderly patients after ICU admission. Intensive Care Med 2009;35:550-555.
Torres OH. Short- and long-term outcomes of older patients in intermediate care units. Intensive Care Med 2006;32:1052-1059.
Walther SM, Jonasson U. Outcome of the elderly critically ill after intensive care in an era of cost containment. Acta Anaesthiol Scand 2004; 48:417-422.