Feb 10, 2019
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.
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