The Surprising Shift in Elderly ICU Admissions

Greg Martin, MD


June 13, 2016

Longitudinal Changes in ICU Admissions Among Elderly Patients in the United States

Sjoding MW, Prescott HC, Wunsch H, Iwashyna TJ, Cooke CR
Crit Care Med. 2016 Mar 10. [Epub ahead of print]


The availability and utilization of intensive care unit (ICU) beds continues to change in the US healthcare system.[1,2] Sjoding and colleagues sought to examine changes in the composition of patients admitted to the ICU by describing the demographic characteristics, diagnoses, and outcomes of patients admitted to critical care units in US hospitals over time.

The authors examined 27.8 million elderly (age > 64 years) Medicare beneficiaries who required ICU care between 1996 and 2010. They noted declines in admissions with a primary diagnosis of cardiovascular disease (coronary artery disease and congestive heart failure) and an increase in infectious diseases with explicitly labeled sepsis, increasing from the 11th-ranked diagnosis in 1996 to the top-ranked primary discharge diagnosis in 2010. Crude in-hospital mortality rose from 11.3% to 12.0%, and there was an increase in discharges to hospice and post-acute care facilities.

The authors concluded that primary diagnoses of elderly ICU patients have changed over the past 15 years, with a shift from cardiovascular care to infectious diseases.


Studies describing the epidemiology of healthcare are often impossible to apply to individual patients, yet they may be invaluable for the purposes of public health, research funding, educators, and institutional planning. In this case, there has been a tremendous shift among elderly Medicare patients away from primarily cardiovascular ICU admission diagnoses to a spate of infectious diseases diagnoses. This is somewhat surprising, given that the elderly population has a high prevalence of cardiovascular disease, but perhaps the increasing ability to provide extensive cardiovascular care outside the ICU has obviated ICU services for some diagnoses. In addition, the improved health cardiovascular health profile of Medicare patients has translated to lower ICU utilization for acute cardiovascular conditions.[3]

With these changes in mind, hospitals and public health planners must consider how best to provide critical care services related to infectious diseases as much as or more than the traditional focus on cardiovascular care.


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