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Understanding and Reducing Disability in Older Adults Following Critical Illness*

Brummel, Nathan E. MD, MSCI1,2,3; Balas, Michele C. PhD, RN, APRN-NP, CCRN4; Morandi, Alessandro MD, MPH3,5,6; Ferrante, Lauren E. MD7; Gill, Thomas M. MD8; Ely, E. Wesley MD, MPH, FCCM1,2,3,9

doi: 10.1097/CCM.0000000000000924
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Objective: To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness.

Data Sources: We searched PubMed, CINAHL, Web of Science and Google Scholar for studies reporting disability outcomes (i.e., activities of daily living, instrumental activities of daily living, and mobility activities) and/or cognitive outcomes among patients treated in an ICU who were 65 years or older. We also reviewed the bibliographies of relevant citations to identify additional citations.

Study Selection: We identified 19 studies evaluating disability outcomes in critically ill patients who were 65 years and older.

Data Extraction: Descriptive epidemiologic data on disability after critical illness.

Data Synthesis: Newly acquired disability in activities of daily living, instrumental activities of daily living, and mobility activities was commonplace among older adults who survived a critical illness. Incident dementia and less severe cognitive impairment were also highly prevalent. Factors related to the acute critical illness, ICU practices, such as heavy sedation, physical restraints, and immobility, as well as aging physiology, and coexisting geriatric conditions can combine to result in these poor outcomes.

Conclusions: Older adults who survive critical illness have physical and cognitive declines resulting in disability at greater rates than hospitalized, noncritically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs.

1Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.

2Department of Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN.

3Department of Medicine, Center for Quality of Aging, Vanderbilt University School of Medicine, Nashville, TN.

4The Ohio State University College of Nursing, Center of Excellence in Critical and Complex Care, Columbus, OH.

5Geriatric Research Group, Brescia, Italy.

6Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy.

7Pulmonary and Critical Care Section, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.

8Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT.

9Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.

* See also p. 1340.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Brummel is supported by the National Institute on Aging under award number R03AG045095, by the Vanderbilt Clinical and Translational Scholars Program and the National Center for the Advancement of Translational Sciences under award number 5KL2TR000446. He has received grant support and support for article research from the National Institutes of Health (NIH). Dr. Balas is supported by Alzheimer’s Association and Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. She has received honoraria from ProCe, the France Foundation, Hospira, Hillrom, Centers for Disease Control, and Cynosure Health. Dr. Ferrante is supported by the National Institute on Aging under award number T32AG19134. She received support for article research from the NIH. Her institution received grant support from the National Institute on Aging (NIA)/NIH. Dr. Gill is the recipient of an Academic Leadership Award from the NIA under award number K07AG043587 and is supported by the NIA/Yale Claude D. Pepper Older Americans Independence Center under award number P30AG21342. He has received honoraria from Novartis. He has received grant support from the NIH and support for article research from the NIH. Dr. Ely is supported by the Veterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC) and by the National Institute on Aging under award number R01AG035117. He has received research grants and/or honoraria from Hospira, Orion, and Abbott. He has received grant support from the NIH and VA; consulted for Hospira, Abbott, Orion, and Masimo; and received support for article research from the NIH. Dr. Morandi disclosed that he does not have any potential conflicts of interest.

Address requests for reprints to: Nathan E. Brummel, MD, MSCI, 2525 West End Avenue, Suite 350 Nashville, TN 37203. E-mail: nathan.brummel@vanderbilt.edu

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