Age differences in survival outcomes and resource use for chronically critically ill patients
Abstract Purpose Chronically critically ill (CCI) patients use a disproportionate amount of resources, yet little research has examined outcomes for older CCI patients. The purpose of this study was to compare outcomes (mortality, disposition, posthospital resource use) between older (≥65 years) and...
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| Veröffentlicht in: | Journal of critical care 2009-06, Vol.24 (2), p.302-310 |
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| creator | Douglas, Sara L., PhD, RN Daly, Barbara J., PhD, RN, FAAN O'Toole, Elizabeth E., MD Kelley, Carol G., PhD, RN Montenegro, Hugo, MD |
| description | Abstract Purpose Chronically critically ill (CCI) patients use a disproportionate amount of resources, yet little research has examined outcomes for older CCI patients. The purpose of this study was to compare outcomes (mortality, disposition, posthospital resource use) between older (≥65 years) and middle-aged (45-64 years) patients who require more than 96 hours of mechanical ventilation while in the intensive care unit. Methods Data from 2 prospective studies were combined for the present examination. In-hospital as well as posthospital discharge data were obtained via chart abstraction and interviews. Results One thousand one hundred twenty-one subjects were enrolled; 62.4% (n = 700) were older. Older subjects had a 1.3 greater risk for overall mortality (from admission to 4 months posthospital discharge) than middle-aged subjects. The Acute Physiology Score (odds ratio [OR], 1.009), presence of diabetes (OR, 2.37), mechanical ventilation at discharge (OR, 3.17), and being older (OR, 2.20) were statistically significant predictors of death at 4 months postdischarge. Older subjects had significantly higher charges for home care services, although they spent less time at home (mean, 22.1 days) than middle-aged subjects (mean, 31.3 days) ( P = .03). Conclusion Older subjects were at higher risk of overall mortality and used, on average, more postdischarge services per patient when compared with middle-aged subjects. |
| doi_str_mv | 10.1016/j.jcrc.2008.02.004 |
| format | Article |
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The purpose of this study was to compare outcomes (mortality, disposition, posthospital resource use) between older (≥65 years) and middle-aged (45-64 years) patients who require more than 96 hours of mechanical ventilation while in the intensive care unit. Methods Data from 2 prospective studies were combined for the present examination. In-hospital as well as posthospital discharge data were obtained via chart abstraction and interviews. Results One thousand one hundred twenty-one subjects were enrolled; 62.4% (n = 700) were older. Older subjects had a 1.3 greater risk for overall mortality (from admission to 4 months posthospital discharge) than middle-aged subjects. The Acute Physiology Score (odds ratio [OR], 1.009), presence of diabetes (OR, 2.37), mechanical ventilation at discharge (OR, 3.17), and being older (OR, 2.20) were statistically significant predictors of death at 4 months postdischarge. Older subjects had significantly higher charges for home care services, although they spent less time at home (mean, 22.1 days) than middle-aged subjects (mean, 31.3 days) ( P = .03). Conclusion Older subjects were at higher risk of overall mortality and used, on average, more postdischarge services per patient when compared with middle-aged subjects.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2008.02.004</identifier><identifier>PMID: 19327287</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Advance Directives ; Age Factors ; Aged ; APACHE ; Chronic Disease ; Critical Care ; Critical Illness - mortality ; Critical Illness - therapy ; Discharge data ; Health Services - statistics & numerical data ; Hospital Mortality ; Hospitals ; Humans ; Intensive Care Units - statistics & numerical data ; Length of Stay ; Long-Term Care - statistics & numerical data ; Long-term mechanical ventilation ; Middle Aged ; Mortality ; Older people ; Patient Discharge - statistics & numerical data ; Respiration, Artificial - statistics & numerical data ; Retrospective Studies ; Studies ; Survival outcomes ; Survival Rate ; Treatment Outcome</subject><ispartof>Journal of critical care, 2009-06, Vol.24 (2), p.302-310</ispartof><rights>Elsevier Inc.</rights><rights>2009 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-6e684441481d1a5a8b69c9bfbecaea085d220056bfc8144e7ac28de4fd40e3143</citedby><cites>FETCH-LOGICAL-c536t-6e684441481d1a5a8b69c9bfbecaea085d220056bfc8144e7ac28de4fd40e3143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1033237933?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,3549,27923,27924,45994,64384,64386,64388,72340</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19327287$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Douglas, Sara L., PhD, RN</creatorcontrib><creatorcontrib>Daly, Barbara J., PhD, RN, FAAN</creatorcontrib><creatorcontrib>O'Toole, Elizabeth E., MD</creatorcontrib><creatorcontrib>Kelley, Carol G., PhD, RN</creatorcontrib><creatorcontrib>Montenegro, Hugo, MD</creatorcontrib><title>Age differences in survival outcomes and resource use for chronically critically ill patients</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Purpose Chronically critically ill (CCI) patients use a disproportionate amount of resources, yet little research has examined outcomes for older CCI patients. The purpose of this study was to compare outcomes (mortality, disposition, posthospital resource use) between older (≥65 years) and middle-aged (45-64 years) patients who require more than 96 hours of mechanical ventilation while in the intensive care unit. Methods Data from 2 prospective studies were combined for the present examination. In-hospital as well as posthospital discharge data were obtained via chart abstraction and interviews. Results One thousand one hundred twenty-one subjects were enrolled; 62.4% (n = 700) were older. Older subjects had a 1.3 greater risk for overall mortality (from admission to 4 months posthospital discharge) than middle-aged subjects. The Acute Physiology Score (odds ratio [OR], 1.009), presence of diabetes (OR, 2.37), mechanical ventilation at discharge (OR, 3.17), and being older (OR, 2.20) were statistically significant predictors of death at 4 months postdischarge. Older subjects had significantly higher charges for home care services, although they spent less time at home (mean, 22.1 days) than middle-aged subjects (mean, 31.3 days) ( P = .03). Conclusion Older subjects were at higher risk of overall mortality and used, on average, more postdischarge services per patient when compared with middle-aged subjects.</description><subject>Advance Directives</subject><subject>Age Factors</subject><subject>Aged</subject><subject>APACHE</subject><subject>Chronic Disease</subject><subject>Critical Care</subject><subject>Critical Illness - mortality</subject><subject>Critical Illness - therapy</subject><subject>Discharge data</subject><subject>Health Services - statistics & numerical data</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Length of Stay</subject><subject>Long-Term Care - statistics & numerical data</subject><subject>Long-term mechanical ventilation</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Older people</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Respiration, Artificial - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Studies</subject><subject>Survival outcomes</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9Ul2L1DAUDaK44-of8EECgm-t-Wqbgiwsi1-w4IP6KCG9vd1NzTRj0g7MvzfdGVzdB58SknPOveeeS8hLzkrOeP12LEeIUArGdMlEyZh6RDa8qppC17x6TDZMa1m0SvEz8iylkTHeSFk9JWe8laIRutmQH5c3SHs3DBhxAkzUTTQtce_21tOwzBC2-dFOPY2YwhIB6ZKQDiFSuI1hcmC9P1CIbj5dnfd0Z2eH05yekyeD9QlfnM5z8v3D-29Xn4rrLx8_X11eF1DJei5qrLXKbSrNe24rq7u6hbYbOgSLlumqF9lkVXcDaK4UNhaE7lENvWIouZLn5OKou1u6LfaQa0frzS66rY0HE6wz__5M7tbchL0RTVsrKbPAm5NADL8WTLPZugTovZ0wLMnUjRRaVyIDXz8AjnkqUzZnOJNSyKa9kxNHFMSQUsThTyucmTU7M5o1O7NmZ5gwObtMevW3iXvKKawMeHcEYB7l3mE0CdyaWu8iwmz64P6vf_GADt7dBfgTD5jufZiUCebruj3r8jDN8vC5lr8BZnrBwQ</recordid><startdate>20090601</startdate><enddate>20090601</enddate><creator>Douglas, Sara L., PhD, RN</creator><creator>Daly, Barbara J., PhD, RN, FAAN</creator><creator>O'Toole, Elizabeth E., MD</creator><creator>Kelley, Carol G., PhD, RN</creator><creator>Montenegro, Hugo, MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090601</creationdate><title>Age differences in survival outcomes and resource use for chronically critically ill patients</title><author>Douglas, Sara L., PhD, RN ; 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The purpose of this study was to compare outcomes (mortality, disposition, posthospital resource use) between older (≥65 years) and middle-aged (45-64 years) patients who require more than 96 hours of mechanical ventilation while in the intensive care unit. Methods Data from 2 prospective studies were combined for the present examination. In-hospital as well as posthospital discharge data were obtained via chart abstraction and interviews. Results One thousand one hundred twenty-one subjects were enrolled; 62.4% (n = 700) were older. Older subjects had a 1.3 greater risk for overall mortality (from admission to 4 months posthospital discharge) than middle-aged subjects. The Acute Physiology Score (odds ratio [OR], 1.009), presence of diabetes (OR, 2.37), mechanical ventilation at discharge (OR, 3.17), and being older (OR, 2.20) were statistically significant predictors of death at 4 months postdischarge. Older subjects had significantly higher charges for home care services, although they spent less time at home (mean, 22.1 days) than middle-aged subjects (mean, 31.3 days) ( P = .03). Conclusion Older subjects were at higher risk of overall mortality and used, on average, more postdischarge services per patient when compared with middle-aged subjects.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>19327287</pmid><doi>10.1016/j.jcrc.2008.02.004</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Advance Directives Age Factors Aged APACHE Chronic Disease Critical Care Critical Illness - mortality Critical Illness - therapy Discharge data Health Services - statistics & numerical data Hospital Mortality Hospitals Humans Intensive Care Units - statistics & numerical data Length of Stay Long-Term Care - statistics & numerical data Long-term mechanical ventilation Middle Aged Mortality Older people Patient Discharge - statistics & numerical data Respiration, Artificial - statistics & numerical data Retrospective Studies Studies Survival outcomes Survival Rate Treatment Outcome |
| title | Age differences in survival outcomes and resource use for chronically critically ill patients |
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