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Pediatrics
Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit
Song-I Lee, Younsuck Koh, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim
Acute Crit Care. 2022;37(3):372-381.   Published online August 4, 2022
DOI: https://doi.org/10.4266/acc.2022.00066
  • 3,328 View
  • 222 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Background
Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.
Methods
We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis.
Results
Comparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.
Conclusions
The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.

Citations

Citations to this article as recorded by  
  • Chronicles of change for the future: The imperative of continued data collection in French ICUs
    Takashi Tagami
    Anaesthesia Critical Care & Pain Medicine.2023; 42(5): 101294.     CrossRef
  • We need a comprehensive intensive care unit management strategy for older patients
    Dong-Ick Shin
    Acute and Critical Care.2022; 37(3): 468.     CrossRef
Infection
In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19
Yong Sub Na, Jin Hyoung Kim, Moon Seong Baek, Won-Young Kim, Ae-Rin Baek, Bo young Lee, Gil Myeong Seong, Song-I Lee
Acute Crit Care. 2022;37(3):303-311.   Published online July 5, 2022
DOI: https://doi.org/10.4266/acc.2022.00017
  • 3,495 View
  • 212 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Background
Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly.
Methods
This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Republic of Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis.
Results
The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis.
Conclusions
The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.

Citations

Citations to this article as recorded by  
  • Omicron, Long-COVID, and the Safety of Elective Surgery for Adults and Children: Joint Guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services
    Philip S. Barie, Mary E. Brindle, Rachel G. Khadaroo, Tara L. Klassen, Jared M. Huston
    Surgical Infections.2023; 24(1): 6.     CrossRef
  • Evaluation of risk scores as predictors of mortality and hospital length of stay for older COVID‐19 patients
    Banu Buyukaydin, Tahsin Karaaslan, Omer Uysal
    AGING MEDICINE.2023; 6(1): 56.     CrossRef
  • Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes
    Joy E. van Son, Elisabeth C. P. Kahn, Jessica M. van der Bol, Dennis G. Barten, Laura C. Blomaard, Carmen van Dam, Jacobien Ellerbroek, Steffy W. M. Jansen, Anita Lekx, Carolien M. J. van der Linden, Roy Looman, Huub A. A. M. Maas, Francesco U. S. Mattace
    European Geriatric Medicine.2023;[Epub]     CrossRef
  • Neurological Manifestations and Complications of the Central Nervous System as Risk Factors and Predictors of Mortality in Patients Hospitalized with COVID-19: A Cohort Study
    Ana Luisa Corona-Nakamura, Martha Judith Arias-Merino, Rayo Morfín-Otero, Guillermo Rodriguez-Zavala, Alfredo León-Gil, Juan Ramsés Camarillo-Escalera, Idarmis Brisseida Reyes-Cortés, María Gisela Valdovinos-Ortega, Erick René Nava-Escobar, Ana María de l
    Journal of Clinical Medicine.2023; 12(12): 4065.     CrossRef
  • Modified Early Warning Score: Clinical Deterioration of Mexican Patients Hospitalized with COVID-19 and Chronic Disease
    Nicolás Santiago González, María de Lourdes García-Hernández, Patricia Cruz-Bello, Lorena Chaparro-Díaz, María de Lourdes Rico-González, Yolanda Hernández-Ortega
    Healthcare.2023; 11(19): 2654.     CrossRef
  • Risk Factors and Predictive Model for Mortality of Hospitalized COVID-19 Elderly Patients from a Tertiary Care Hospital in Thailand
    Mallika Chuansangeam, Bunyarat Srithan, Pattharawin Pattharanitima, Pawit Phadungsaksawasdi
    Medicines.2023; 10(11): 59.     CrossRef
Trauma
Elixhauser comorbidity measures-based risk factors associated with 30-day mortality in elderly population after femur fracture surgery: a propensity scorematched retrospective case-control study
Dohyung Kim, Hyunmin Jo, Younsuk Lee, Kyoung Ok Kim
Acute Crit Care. 2020;35(1):10-15.   Published online February 29, 2020
DOI: https://doi.org/10.4266/acc.2019.00745
  • 5,469 View
  • 123 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
As the average life expectancy increases, anesthesiologists confront unique challenges in the perioperative care of elderly patients who have significant comorbidities. In this study, we evaluated Elixhauser comorbidity measures-based risk factors associated with 30day mortality in patients aged 66 years and older who underwent femur fracture surgery. Methods: We used the Medical Information Mart for Intensive Care III which contains the medical records of patients admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center in the United States between 2001 and 2012 to identify patients admitted to the ICU after femur fracture surgery (n=209). Patients who died within 30 days of admission (case group, n=49) were propensity score-matched to patients who did not (control group, n=98). The variables for matching were age, sex, race, anemia (hemoglobin ≤10 g/dl), and malignancy. We attempted to explain mortality via nine independent factors: hypertension, uncomplicated diabetes, complicated diabetes, congestive heart failure (CHF), cardiac arrhythmias, chronic pulmonary disease, renal failure, neurological disorders other than paralysis, and peripheral vascular disease. Results: Logistic regression identified three significant risk factors: CHF, arrhythmias, and neurological disorders other than paralysis. The odds ratio (OR) for the 30-day mortality of CHF was 4.99 (95% confidence interval [CI], 2.18 to 12.06). The equivalent ORs for cardiac arrhythmias and neurological disorders other than paralysis were 2.61 (95% CI, 1.14 to 6.21) and 2.40 (95% CI, 0.95 to 6.48), respectively. Conclusions: Identifying patients with these risk factors (CHF, arrhythmias, and neurological disorders other than paralysis) will assist clinicians with perioperative planning and provide caregivers with valuable information for decision-making.

Citations

Citations to this article as recorded by  
  • A machine learning-based prediction model for in-hospital mortality among critically ill patients with hip fracture: An internal and external validated study
    Mingxing Lei, Zhencan Han, Shengjie Wang, Tao Han, Shenyun Fang, Feng Lin, Tianlong Huang
    Injury.2023; 54(2): 636.     CrossRef
  • Complications and hospitalization costs in patients with hypothyroidism following total hip arthroplasty
    Yuanyuan Huang, Yuzhi Huang, Yuhang Chen, Qinfeng Yang, Binyan Yin
    Journal of Orthopaedic Surgery and Research.2023;[Epub]     CrossRef
  • How age and gender influence proximal humerus fracture management in patients older than fifty years
    Akshar H. Patel, J. Heath Wilder, Sione A. Ofa, Olivia C. Lee, Michael C. Iloanya, Felix H. Savoie, William F. Sherman
    JSES International.2022; 6(2): 253.     CrossRef
  • Comorbidity indices in orthopaedic surgery: a narrative review focused on hip and knee arthroplasty
    SaTia T. Sinclair, Ahmed K. Emara, Melissa N. Orr, Kara M. McConaghy, Alison K. Klika, Nicolas S. Piuzzi
    EFORT Open Reviews.2021; 6(8): 629.     CrossRef
Pulmonary/Quality Improvement
Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea
Junghyun Kim, Jungkyu Lee, Sunmi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee
Korean J Crit Care Med. 2016;31(1):25-33.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.25
  • 5,153 View
  • 106 Download
  • 2 Crossref
AbstractAbstract PDF
Background:
The number of elderly patients admitted to intensive care units (ICUs) is growing with the increasing proportion of elderly persons in the Korean general population. It is often difficult to make decisions about ICU care for elderly patients, especially when they are in their 90s. Data regarding the proportion of elderly patients in their 90s along with their clinical characteristics in ICU are scarce.
Methods
The records of Korean patients ≥ 90 years old who were admitted to the medical ICU in a tertiary referral hospital between January 2005 and December 2014 were retrospectively reviewed. We compared the trend in ICU use and characteristics of these elderly patients between 2005-2009 and 2010-2014.
Results
Among 6,186 referred patients, 55 aged ≥ 90 years were admitted to the medical ICU from 2005 to 2014. About 58.2% of these patients were male, and their mean age was 92.7 years. Their median Charlson comorbidity index score was 2 (IQR 1-3) and their mean APACHE II score was 25.0 (IQR 19.0-34.0). The most common reason for ICU care was acute respiratory failure. There were no differences in the survival rates between the earlier and more recent cohorts. However, after excluding patients who had specified “do not resuscitate” (DNR), the more recent group showed a significantly higher survival rate (53.8% mortality for the earlier group and 0% mortality for the recent group). Among the survivors, over half were discharged to their homes. More patients in the recent cohort (n=26 [78.8%]) specified DNR than in the earlier cohort (n=7 [35.0%], p=0.004). The number and proportion of patients ≥ 90 years old among patients using ICU during the 2005-2014 study period did not differ.
Conclusions
The use of ICU care by elderly patients ≥ 90 years old was consistent from 2005-2014. The overall mortality rate tended to decrease, but this was not statistically significant. However, the proportion of patients specifying DNR was higher among more recent patients, and the recent group showed an even better survivorship after sensitivity analysis excluded patients specifying DNR.

Citations

Citations to this article as recorded by  
  • Evaluating the effect of age on postoperative and clinical outcomes in patients admitted to the intensive care unit after gastrointestinal cancer surgery
    Jee Yeon Lee, Hyejeong Park, Mi Kyoung Kim, Im-kyung Kim
    Surgery.2022; 172(4): 1270.     CrossRef
  • Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit
    Song-I Lee, Younsuck Koh, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim
    Acute and Critical Care.2022; 37(3): 372.     CrossRef
Case Report
A Case of Acute on Chronic Salicylate Poisoned Elderly Patient with Early Utilization of Continuous Venovenous Hemodiafiltration: A Case Report
Ji Sook Lee, Woo Chan Jeon, Young Gi Min, Won Hyun Ryu, Yoon Seok Jung, Sang Cheon Choi
Korean J Crit Care Med. 2011;26(3):177-180.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.177
  • 2,559 View
  • 45 Download
AbstractAbstract PDF
Salicylate poisonings are divided into acute and chronic syndromes. The most challenging aspect of the management of aspirin-poisoning may be recognition of subtle signs and symptoms of chronic, unintentional overdose. Chronic poisoning typically occurs in elderly as a result of unintentional overdosing on salicylates used to treat chronic conditions. Treatment is directed toward preventing intestinal absorption of the drugs and enhanced elimination. After the first-line treatments, aspirin overdose with its complications of hemodynamic, electrolyte and acid-base issues, is best managed by prompt hemodialysis. We report a case of a 87-year-old woman, who presented with acute on chronic salicylate poisoning. After early continuous venovenous hemodiafiltration, old woman made a good recovery from the salicylism but suffered paralytic ileus caused by aspirin enteroliths. Physician can decide a prompt hemodialysis for salicylate-poisoned patients, who worsen clinical courses despite of first-line therapies.

ACC : Acute and Critical Care