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Original Research: CRITICAL CARE |

Do Elderly Patients Fare Well in the ICU?

Brian H. Nathanson, PhD; Thomas L. Higgins, MD, MBA; Maura J. Brennan, MD; Andrew A. Kramer, PhD; Maureen Stark, MS; Daniel Teres, MD
Author and Funding Information

From OptiStatim, LLC (Dr Nathanson), Longmeadow, MA; Baystate Medical Center (Drs Higgins and Brennan), Tufts University School of Medicine, Springfield, MA; Cerner Corporation (Dr Kramer and Ms Stark), Kansas City, MO; and Tufts University School of Medicine (Dr Teres), Springfield, MA.

Correspondence to: Brian H. Nathanson, PhD, OptiStatim, LLC, PO Box 60844, Longmeadow, MA 01116; e-mail: brian.h.nathanson@att.net


Funding/Support: This work was supported by the Cerner Corporation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):825-831. doi:10.1378/chest.10-1233
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Background:  A recent update of the Mortality Probability Model (MPM)-III found 14% of intensive care patients had age as their only MPM risk factor for hospital mortality. This subgroup had a low mortality rate (2% vs 14% overall), and pronounced differences were noted among elderly patients. This article is an expanded analysis of age-related mortality rates in patients in the ICU.

Methods:  Project IMPACT data from 135 ICUs for 124,885 patients treated from 2001 to 2004 were analyzed. Patients were stratified as elective surgical, emergency/unscheduled surgical, and medical and then further stratified by age and whether additional MPM risk factors were present or absent.

Results:  Mortality rose with advancing age within all patient categories. Elective surgical patients without other risk factors were the least likely to die at all ages (0.4% for patients aged 18-29 years to 9.2% for patients aged ≥ 90 years), whereas medical patients with one or more additional risk factors had the highest mortality rate (12.1% for patients aged 18-29 years to 36.0% for patients aged ≥ 90 years). In these two subsets, mortality rates approximately doubled in the elective surgical group among patients aged in their 70s (2.4%), 80s (4.3%), and 90s (9.2%) but rose less dramatically in the medical group (27.0%, 30.7%, and 36.0%, respectively).

Conclusions:  Although mortality increased with age, the risk differed significantly by patient subset, even among elderly patients, which may reflect a selection bias. Advanced age alone does not preclude successful surgical and ICU interventions, although the presence of serious comorbidities decreases the likelihood of survival to discharge for all age groups.

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