What is the importance of age on treatment of the elderly in the intensive care unit?

BACKGROUND: By 2050, the percentage of the population older than 80 years will double, and some data suggest that elderly patients receive less advanced treatment. Information of outcome in elderly (≥ 65 year), representing roughly half the intensive care unit (ICU) admissions, in Sweden is scarce.

METHODS: Retrospective cohort study. We included all critically ill patients aged 65 or older (n = 605), admitted to the ICU during the years 2010-2011. Patients were categorized into two age groups: 65-79 (64%) and above 80 (36%). Demographic and epidemiology data were registered, as well as primary diagnosis, Simplified Acute Physiology Score III (SAPS III) mortality (ICU and hospital), withhold/withdraw life-sustaining treatment, the ICU workload, length of stay (ICU and hospital) and discharge location.

RESULTS: Hospital mortality was significantly higher in patients above 80 years compared with patients 65-79 years of age (33.7% vs. 22.8%). These patients received less treatment and obtained more limitations in care (withhold/withdraw life-sustaining treatments). Patients above 80 years received less invasive ventilatory support (28.3% vs. 37.8%) and shorter length of invasive ventilatory support (1.1 ± 3.9 vs. 2.9 ± 7.4) compared with patients aged 65-79. In multivariate analysis, patients ≥ 80 years received less mechanical ventilation and more limitations in care even after adjustment for SAPS III and comorbidity.

CONCLUSIONS: Patients above 80 years received less treatment and obtained more limitations in life-sustaining treatments compared with patients aged 65-79, even after adjustment for severity of illness and comorbidity.