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Short-term outcomes in older intensive care unit patients with dementia*

Pisani, Margaret A. MD, MPH; Redlich, Carrie A. MD, MPH; McNicoll, Lynn MD; Ely, E Wesley MD, MPH; Friedkin, Rebecca J. PhD; Inouye, Sharon K. MD, MPH

doi: 10.1097/01.CCM.0000165558.83676.48
Neurologic Critical Care

Objective: To determine the impact of dementia on the outcomes of intensive care unit (ICU) care and use of ICU interventions among older patients.

Design: Prospective observational cohort study.

Setting: Urban university teaching hospital.

Patients: Patients were 395 patients age ≥65 consecutively admitted to a medical ICU.

Interventions: None.

Measurements and Main Results: Dementia was determined by a previously validated proxy measure, the Modified Blessed Dementia Rating Scale. We chose cut points to focus on patients with moderate-severe dementia at baseline. Our primary outcomes included length of mechanical ventilation and ICU and hospital length of stay. Secondary outcomes included ICU readmission, changes in code status, discharge location, mortality, and use of ICU interventions. Medical record abstraction was performed to determine the rates of ICU outcomes, use of ICU interventions, and potential confounders. Our study documented a prevalence of moderate-severe dementia of 17% in patients age ≥65 admitted to the ICU. Patients with dementia were significantly older (80 vs. 76), more likely to be female (65% vs. 52%), and more likely to be admitted from a nursing home (46% vs. 11%). Patients with dementia had significantly higher Acute Physiology and Chronic Health Evaluation II scores on admission to the ICU (25 vs. 23). Patients with dementia were more likely to have their code status changed to less aggressive in the ICU (24% vs. 14%). There was no significant difference in readmission to the ICU, discharge location, ICU or hospital mortality rate, or use of ICU interventions between patients with and without dementia.

Conclusions: Our study documents no difference in outcomes from ICU care in older patients with and without dementia. There was no increased short-term mortality rate in older patients with dementia compared with those without dementia after admission to the ICU. Presumptions that outcomes from critical care are less favorable in patients with dementia should not drive treatment decisions in the ICU.

From the Department of Internal Medicine, Yale University School of Medicine (MAP, CAR, SKI); Department of Internal Medicine, Brown University School of Medicine (LM); and Department of Medicine and Center for Health Services Research, Veterans Affairs Geriatric Research and Clinical Education Center, and the Vanderbilt University School of Medicine (EWE).

Supported, in part, by the American Lung Association; grant CG-002-N from the Connecticut Thoracic Society; grant P30AG21342 from the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine, and grant RO1 AG12551 from the National Institutes of Health. Dr. Pisani is a recipient of a Merck/AFAR Junior Investigator Award in Geriatric Clinical Pharmacology, American Lung Association Clinical Research Grant, Franklin T. Williams Geriatric Development Initiative through The CHEST Foundation, ASP, Hartford Foundation, Yale Pepper Center Early Career Development Award, Yale Mentored Clinical Scholar Program (K12) Award, and a NIH K23 (K23 AG 23023-01A1) Career Development Award. Dr. Inouye is a recipient of a Midcareer Award from the National Institute on Aging (K24AG00949). Dr. Ely is a recipient of the AFAR Pharmacology in Aging Grant and the Paul Beeson Faculty Scholar Award from the American Federation for Aging Research/Hartford Foundation. Dr. Redlich is a recipient of an NIH Midcareer Award (K24ES00355).

Address requests for reprints to: Margaret A. Pisani, MD, MPH, Yale University School of Medicine Pulmonary & Critical Care Medicine, 333 Cedar Street, P.O. Box 208057, New Haven, CT 06520-8057. E-mail: Margaret.Pisani@yale.edu

© 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins