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Predictors of Mortality in Older Patients following Medical Intensive Care: The Importance of Functional Status
Author(s) -
MayerOakes S. Allison,
Oye Robert K.,
Leake Barbara
Publication year - 1991
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1991.tb04452.x
Subject(s) - medicine , comorbidity , intensive care unit , medical record , logistic regression , retrospective cohort study , intensive care , emergency medicine , pediatrics , intensive care medicine
Objective: We examined predictors of hospital and 6‐month mortality in older Medical Intensive Care Unit (MICU) patients with particular attention to age and functional status. Age is generally thought to be strongly associated with intensive care outcomes, but this relationship may be confounded by age‐related changes. These age‐related changes may be approximated by changes in functional status (FS). Design: We conducted a retrospective chart review and collected severity of illness data using the Acute Physiology Score (APS), pre‐hospitalization FS dichotomized as limited or not limited, and hospital mortality. County death records were reviewed for 6‐month mortality Setting: Three community hospital MICUs. Patients: Four‐hundred MICU patients aged 50 and older admitted during the study period. Results: Limited FS was found in 42% of the 227 patients who had FS data in the chart. Mortality was significantly associated with APS, age, FS, immunocompromise state, comorbidity, and nursing home residence. In logistic regression analyses, while controlling for important variables, APS (P < 0.001) and age ≥75 with limited FS (P < 0.05) were associated with hospital mortality. Six‐month mortality predictors were APS (P < 0.001), hospital (P < 0.05), immunocompromised state (P < 0.05) and age ≥75 with limited FS (P < 0.05). Conclusions: We found that among patients without functional limitations, the oldest group was no more likely to die than the youngest group. Age and functional status had a significant interaction: patients older than 75 years with functional limitations were almost six times more likely to die in hospital compared to the reference group of patients between 50–64 years old without functional limitations. We conclude that functional status is an important predictor of outcome in older MICU patients.