Abstract

Objective: To compare “elderly” (≥80yrs), “older” (65-79) and “younger” (<65yrs) ICU admissions in Scotland in relation to: trends in admission rates; regional variation in admissions; ICU treatment intensity; and ICU and one year mortality.Design: National five year cohort study of ICU first admissions (01/01/2005-31/12/2009). Setting: All admissions to ICUs and combined units (Level 2/3 care) in Scotland captured by the Scottish Intensive Care Society Audit Group database, linked with hospital discharge data and death records.Patients: 40,142 patients: 3,865 were ≥80yrs (9.6%); 13,904 (34.6%) 65-79yrs; and 22,373 <65yrs (55.6%).Interventions: None.Measurements and Main Results: Between 2005 and 2009, elderly admission rates decreased from 36.6 (95%CI 34.0-39.2) to 28.7 (95%CI 26.5-30.9) per 10,000 population (P<0.001; relative decrease: 22.0%); older admission rates also decreased, but less steeply (31.1 (95%CI 29.9-32.2) to 26.1 (95%CI 25.1-27.1) per 10,000 population, p<0.001; relative decrease 16.1%). Rates were static for younger patients. Restricted to mechanically ventilated elderly patients, rates ranged from 13.9 to 30.1/10,000 between healthboard administrative regions (P<0.001). Emergency surgical diagnoses were more prevalent for elderly patients (39.8% older (25.1%) and younger cohorts (20.3%); P<0.001). Subgroup analyses limited to pneumonia admissions (elderly (n=242), older (n=1,226), younger (n=1,835)) indicated similar acute physiology scores, but fewer pre-existing comorbidities among elderly patients (P=0.007), who received a shorter duration of organ support and ICU stay. Mortality rates were higher in elderly patients at ICU discharge (elderly 26.5%; older 25.0%; younger 17.0%; p<0.001; confounder adjusted (adj) OR elderly vs younger 2.33 (95%CI 2.11-2.58; p<0.001). Differences persisted at one year (elderly 52.2%; older 43.8%; younger 27.6%, adjOR elderly vs younger 3.72 (95%CI 3.42-4.06; p<0.001). Conclusions: In Scotland, elderly and older ICU admission rates are decreasing, with regional geographical variation. Although limited by an absence of a measure of frailty, patient characteristics and treatment intensity suggest selection of less comorbid elderly patients, indicating possible rationing based on chronological age.
Original languageEnglish
Pages (from-to)3-13
JournalCritical Care Medicine
Volume44
Issue number1
DOIs
Publication statusPublished - Jan 2016

Keywords

  • Critical Care
  • elderly
  • cohort studies
  • admission
  • outcomes
  • epidemiology

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