Dr Chow Fu Loi
Intensive Care Unit, Caritas Medical Centre (December 2001 Critical Care Medicine Exit Assessment Exercise)

Abstract
 
Objectives To assess whether older ICU patients have less favourable outcome in terms of
survival and functional status, as well as difference in resource utilization and limitation of
therapy.
 

Design Retrospective.

Setting ICU of a district hospital.

Patients 515 consecutive patients over twelve months.

Measurements APACHE II score and modified APACHE II score without including age and
chronic health evaluation (APS) were used for assessment of severity of acute illness. Modified
Katz scale of activities of daily living was used to evaluate functional status. Mortality in ICU,
hospital, and at 6 months was documented. Information of functional and residential status was
noted at baseline and 6 months. The use of major interventions in ICU, length of stay in ICU and
hospital, and frequency of limitation of therapy were recorded.

Results The mean age of the entire sample was 65 years. Although both short-term and long-term
mortality were increased in older patients, age was not an independent predictor of ICU death.
Older patients were more likely to be functionally dependent and nursing home residents at
baseline and at 6 months. Their hospital stay after discharge from ICU was longer. All hospital
survivors had similar survival rate at 6 months regardless of age. Limitation of life support was
more frequent with increasing age.

Conclusions Older patients have less favourable outcomes and longer hospitalisation. Prudential
patient selection for intensive care and judicious adoption of limitation of therapy are required in
the presence of an ageing population. Effective communication and comfort are crucial to the
achievement of good end-of-life care.