Frailty Before Critical Illness and Mortality for Elderly Medicare Beneficiaries
© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society..
OBJECTIVES: To estimate the effect of pre-intensive care unit (ICU) health categories on mortality during and after critical illness, focusing specifically on the effect of pre-ICU frailty on short- and long-term mortality.
DESIGN: Retrospective cohort study.
SETTING: Medicare claims data from 2004 to 2008.
PARTICIPANTS: A nationally representative sample of elderly Medicare beneficiaries admitted to an ICU in 2005.
MEASUREMENTS: Participants were classified into four pre-ICU health categories (robust, cancer, chronic organ failure, frailty) using claims data from the year before admission, allowing for assignment to multiple categories. The association between pre-ICU health category and hospital and 3-year mortality was assessed using multivariable logistic regression and Cox proportional hazards models.
RESULTS: Of 47,427 elderly individuals in the ICU, 18.8% were robust, 28.6% had cancer, 68.1% had chronic organ failure, and 34.0% were frail; 41.3% qualified for multiple categories. Overall hospital mortality was 12.6%, with the lowest mortality for robust participants (9.7%). Participants with pre-ICU frailty had higher hospital mortality than those with the same pre-ICU health categories without frailty. (Adjusted odds ratios ranged from 1.27 (95% confidence interval (CI) 1.10-1.47) to 1.52 (95% CI = 1.35-1.63).) Robust hospital survivors had the lowest 3-year mortality (24.6%). Pre-ICU frailty conferred higher 3-year mortality than pre-ICU categories without frailty. (Adjusted hazard ratios ranged from 1.54 (95% CI = 1.45-1.64) to 1.84 (95% CI = 1.70-1.99).).
CONCLUSION: Critically ill elderly adults can be categorized according to pre-ICU health categories. These categories, particularly pre-ICU frailty, may be important for understanding risk of death during and after critical illness.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2015 |
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| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:63 |
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| Enthalten in: |
Journal of the American Geriatrics Society - 63(2015), 6 vom: 13. Juni, Seite 1121-8 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hope, Aluko A [VerfasserIn] |
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| Links: |
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| Themen: |
Aged |
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| Anmerkungen: |
Date Completed 11.09.2015 Date Revised 08.04.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.1111/jgs.13436 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a Date Revised 08.04.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society. | ||
| 520 | |a OBJECTIVES: To estimate the effect of pre-intensive care unit (ICU) health categories on mortality during and after critical illness, focusing specifically on the effect of pre-ICU frailty on short- and long-term mortality | ||
| 520 | |a DESIGN: Retrospective cohort study | ||
| 520 | |a SETTING: Medicare claims data from 2004 to 2008 | ||
| 520 | |a PARTICIPANTS: A nationally representative sample of elderly Medicare beneficiaries admitted to an ICU in 2005 | ||
| 520 | |a MEASUREMENTS: Participants were classified into four pre-ICU health categories (robust, cancer, chronic organ failure, frailty) using claims data from the year before admission, allowing for assignment to multiple categories. The association between pre-ICU health category and hospital and 3-year mortality was assessed using multivariable logistic regression and Cox proportional hazards models | ||
| 520 | |a RESULTS: Of 47,427 elderly individuals in the ICU, 18.8% were robust, 28.6% had cancer, 68.1% had chronic organ failure, and 34.0% were frail; 41.3% qualified for multiple categories. Overall hospital mortality was 12.6%, with the lowest mortality for robust participants (9.7%). Participants with pre-ICU frailty had higher hospital mortality than those with the same pre-ICU health categories without frailty. (Adjusted odds ratios ranged from 1.27 (95% confidence interval (CI) 1.10-1.47) to 1.52 (95% CI = 1.35-1.63).) Robust hospital survivors had the lowest 3-year mortality (24.6%). Pre-ICU frailty conferred higher 3-year mortality than pre-ICU categories without frailty. (Adjusted hazard ratios ranged from 1.54 (95% CI = 1.45-1.64) to 1.84 (95% CI = 1.70-1.99).) | ||
| 520 | |a CONCLUSION: Critically ill elderly adults can be categorized according to pre-ICU health categories. These categories, particularly pre-ICU frailty, may be important for understanding risk of death during and after critical illness | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
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| 650 | 4 | |a aged | |
| 650 | 4 | |a critical illness | |
| 650 | 4 | |a frailty | |
| 650 | 4 | |a prognosis | |
| 700 | 1 | |a Gong, Michelle N |e verfasserin |4 aut | |
| 700 | 1 | |a Guerra, Carmen |e verfasserin |4 aut | |
| 700 | 1 | |a Wunsch, Hannah |e verfasserin |4 aut | |
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