Outcomes for elderly patients in Intensive Care: Camilla Strom
Camilla Strom discusses the outcomes for elderly patients in the intensive care. Camilla recognises a persistent “negative vibe” when people talk about elderly patients. This is inappropriate. We should acknowledge older patients for what they are! They are survival masters. This group of people have experience wars, famines, and recessions. They have seen many failures and successes in their long lives. They have overcome all in their path to be where they are today. Healthcare is facing an oncoming flood of older patients. In fact, this process is already happening across the world. The challenge is that these patients cost a lot of money to care for – especially in the ICU. In the general population, there is a 10% 1-year mortality rate for those 80 years and above. This jumps to 40% if they are admitted to hospital. If a patient older than 80 years is admitted to the ICU there is a 50-90% 1-year mortality rate. Therefore, the question is, should this population be admitted to ICU at all? Camilla argues that age is really much more than a number! Life is a deteriorating process. We pay to live our lives. We pay through the accumulation of DNA damage, through shortened telomeres, diminished physiological reserves and loss of muscle function and strength. These are all unavoidable occurrences. Consequently, it is these things we must consider when caring for the elderly people in our communities. Unfortunately, there is a dearth of data when looking patient outcomes in various settings in the hospital. As a result, we have limited prognostication tools. With more research on the way utilising various scores – more concerned with frailty than age – this will change in the future. With that being said, Camilla urges us to consider the patient as more than their age. Age should not be the limit when deciding who should or should not be admitted to the ICU. Talk to your older patients. Determine what is important to them and use your clinical knowledge to help guide their decision-making process. Finally, set realistic goals and re-evaluate them regularly. For more like this, head to our podcast page. #CodaPodcast
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Outcomes for elderly patients in Intensive Care: Camilla Strom
- 1. Camilla Strøm, MD, PhD # dr_stroem camilla007@gmail.com SHOULD WE BE ADMITTING OVER 80’S TO THE ICU? #survivalmasters
- 2. THE SILVER TSUNAMI Modified from Luo Jie / China Daily
- 3. Chin-Yee Crit Care 2017 Non-survivor CAD 38,820 USD 29,340 EUR 26,260 COSTS
- 4. POPULATION 80+ Modified Hanson 2016
- 5. 1-YEAR MORTALITY 80+ COMMUNITY DWELLING Danmarks Statistik Venligst udlånt af Læge Stine Hanson Modified Hanson 2016
- 6. 1-YEAR MORTALITY 80+ ADMITTED TO HOSPITAL Data fra OUH, SVS Venligst udlånt af Læge Stine Hanson Modified Hanson 2016
- 7. 1-YEAR MORTALITY 80+ ADMITTED TO ICU Data fra OUH, SVS Venligst udlånt af Læge Stine Hanson Modified Hanson 2016
- 8. SO YOU’RE TELLING ME THERE IS! A CHANCE ?
- 9. ”AGE IS JUST A NUMBER” PHYSIOLOGICAL RESERVE SARCOPENIA IMMUNOSENESCENCE
- 10. Besidine 2008, Modified by Uptodate PHYSIOLOGICAL RESERVE
- 11. Bagshaw Crit Care 2008, Boumendil J Am Geriatr Soc 2005, Boumendil PLoS One 2012, Hamel Ann Intern Med 1999, Somme Intensive Care Med 2003
- 12. AGEISM
- 13. Garrouste-Orgeas Crit Care Med 2009, Heyland Intensive Care Med 2015, Le Guen Age Ageing 2016, Phillippart Intensive Care Med 2013 ASK
- 14. Carpenter 2014, Goldstein CGJ 2012, Pugh Crit Care 2014, Garrouste-Orgeas, Rooij 2005,Sprung Crit Care Med 2012 SOFA APACHE SAPS ISAR iADL CLINICAL FRAILTY SCALE CGA Bright TRST VEQ PHYSIOLOGY FUNCTION & FRAILTY FS
- 15. 2015 Becker Ann Intensive Care 2015
- 16. Becker Ann Intensive Care 2015 Becker Ann Intensive Care 2015
- 18. Quality of life Andersen Crit Care 2017, Heyland 2015, Kaarlola Crit Care Med, Sacanella Crit Care 2011 Functional status Boumendil 2012, Heyland Intensive Care Med 2015, Sacanella Crit Care 2011 Geriatric Syndromes Sacanella Crit Care 2011
- 19. IN THE PIPELINE Frailty in the critically ill Wilhelmus 2016 Pugh, Prospero Flaaten, Clincialtrials.gov NCT03134807 Impact of guidelines for ICU admission Pugh, Prospero Flaaten, Clincialtrials.gov NCT03134807 ICE-CUBII study, Clinicaltrials.gov NCT01508819 Multimodal regimens Verceles, Clincialtrials.gov NCT02509520
- 20. SHOULD WE BE ADMITTING OVER 80’S TO THE ICU?
- 21. TAKE HOME Know the limitations of the evidence Know the limitations of your patient Know your patient’s preferences Set realistic goals Re-evaluate Get involved in Research!
- 22. #survivalmasters Camilla Strøm, MD, PhD # dr_stroem camilla007@gmail.com