Outcomes of Intensive Care Patients Older Than 90 Years

An 11-Year National Observational Study

Lenneke E. M. Haas MD; Ferishta Bakhshi-Raiez PhD; Diederik van Dijk MD, PhD; Dylan W. de Lange MD, PhD; Nicolette F. de Keizer PhD

Disclosures

J Am Geriatr Soc. 2020;68(8):1842-1846. 

In This Article

Abstract and Introduction

Abstract

Background/Objectives: Many intensive care unit (ICU) physicians are reluctant to admit patients aged 90 years and older, although evidence to support these decisions is scarce. Although the body of evidence on outcomes of patients aged 80 years and older is growing, it does not include patients aged 90 years and older. The aim of this study was to compare the short- and long-term mortality of ICU patients aged 90 years and older in the Netherlands with ICU patients aged 80 to 90 years, that is, octogenarians.

Design: Multicenter national cohort study over an 11-year period (2008–2018), using data of the National Intensive Care Evaluation (NICE) registry and the Dutch insurance claims registry.

Setting: All 82 ICUs in the Netherlands.

Participants: All patients aged 80 years and older at the time of ICU admission.

Measurements: A total of 104,754 patients aged 80 years and older, of whom 9,495 (9%) were 90 years and older, were admitted to Dutch ICUs during the study period.

Results: ICU mortality of the patients aged 90 years and older was lower (13.8% vs 16.1%; P < .001) and hospital mortality was similar (26.1% vs 25.7%; P = .41) compared with octogenarians. After 3 months, mortality was higher for the patients aged 90 years and older (43.1% vs 33.7%; P < .001) and after 1-year mortality was 55.0% vs 42.7%; P < .001.

Conclusion: In the Netherlands, mortality rates of patients aged 90 years and older admitted to the ICU are not as disappointing as often assumed. They have a lower ICU mortality and a similar hospital mortality compared with octogenarians. Nevertheless, their longer term mortality is higher compared with octogenarians. However, almost 3 of 4 patients leave the hospital alive, and almost half of the patients aged 90 years and older are still alive 1 year after their ICU admission.

Introduction

Worldwide, the number of persons aged 90 years and older rose from less than 7 million in 1995 to more than 12 million in 2010, and it is expected to exceed 76 million in 2050.[1] In the Netherlands, their proportion might triple in the upcoming decade.[2] As a consequence, patients aged 90 years and older compose an expanding subgroup in the hospitals and in the intensive care units (ICUs) (Supplementary Figure S1A and B).[2–4]

In the last decade, multiple studies were published about older ICU patients (defined as ≥80 years of age).[5] It was demonstrated that these patients are responsible for a substantial proportion of hospital and ICU admission days, that their mortality risk is high, and when they survive, they more often experience functional decline and long-term sequelae.[6–9] However, although the body of evidence on outcomes of patients aged 80 years and older is growing, it does not include patients aged 90 years and older. Outcome data of patients aged 90 years and older admitted to the ICU are relatively scarce. In the future, intensivists will probably be confronted more often with the question whether admission of these patients to the ICU is beneficial.

Although age is an important prognostic factor, other factors such as frailty and illness severity are more important.[10–12] However, many ICU physicians use age as a triage criterion, and many seem reluctant to admit patients aged 90 years and older.[13] More insight into the outcomes of these patients is needed to support decisions about ICU treatment of patients aged 90 years and older.

Therefore, the aim of this study was to compare the short- and long-term mortality of ICU patients aged 90 years and older in the Netherlands with ICU patients aged 80 to 90 years.

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