Functional outcome after critical illness in older patients: a population-based study

ABSTRACT

Purpose

To determine the prevalence of disability among ICU survivors one year after admission, and which factors influence functional outcome.

Methods

We examined consecutive patients enrolled in the population-based Mayo Clinic Olmsted Study of Aging and then admitted to medical or surgical adult ICUs at Mayo Clinic, Rochester between January 1, 2006, and December 31, 2014 to determine one-year functional outcomes.

Results

831cases were included. Mean age was 84 years (IQR 79–88). 569 (68.5%) patients were alive one year after ICU admission. Of them, 546 patients had functional assessment at one year and 367 (67.2%) had good functional outcome. On multivariable analysis, poor one-year functional outcome (death or disability) was more common among women, older patients, and patients with baseline cognitive impairment (mild cognitive impairment or dementia), higher Carlson scores, and longer ICU stay (all P <.01). After excluding deceased patients, these associations remained unchanged. In addition, 120 (32.3%) of 372 patients who had post-ICU cognitive evaluation experienced cognitive decline after the ICU admission.

Conclusions

On a population-based cohort of older, predominantly elderly patients, approximately two-thirds of survivors maintained or regained good functional status 1 year after ICU hospitalization. However, older age, female sex, greater comorbidities, abnormal baseline cognition, and longer ICU stay were associated with poor functional recovery and cognitive decline was common.

KEY WORDS:

• Older adults
• critical illness
• functional outcome
• cognitive impairment
• disability

Data availability statement

Data from the Mayo Clinic Study of Aging, including data from this study, are available upon request.

Disclosure statement

The authors declare that they have no conflict of interest.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was made possible, in part, by funding from the National Institute of Aging (U01 AG006786, P50 AG16574, and R01 AG034676).

Notes on contributors

Mania Hajeb

Dr. Mania Hajeb is a Research Fellow in the Mayo Clinic Department of Neurology. Dr. Singh is a resident in Neurology. Dr. Sakusic is on the staff of the University Clinical Center of Tuzla (Bosnia and Herzegovina). Dr. Graff-Radford is an Associate Professor of Neurology in the Mayo Clinic College of Medicine and Science. Dr. Gajic is Professor of Pulmonary and Critical Care in the Mayo Clinic College of Medicine and Science. Dr. Rabinstein is Professor of Neurology in the Mayo Clinic College of Medicine and Science.