Frailty before critical illness and mortality for elderly medicare beneficiaries

Aluko A. Hope, Michelle Ng Gong, Carmen Guerra, Hannah Wunsch

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objectives To estimate the effect of pre-intensive care unit (ICU) health categories on mortality during and after critical illness, focusing specifically on the effect of pre-ICU frailty on short- and long-term mortality. Design Retrospective cohort study. Setting Medicare claims data from 2004 to 2008. Participants A nationally representative sample of elderly Medicare beneficiaries admitted to an ICU in 2005. Measurements Participants were classified into four pre-ICU health categories (robust, cancer, chronic organ failure, frailty) using claims data from the year before admission, allowing for assignment to multiple categories. The association between pre-ICU health category and hospital and 3-year mortality was assessed using multivariable logistic regression and Cox proportional hazards models. Results Of 47,427 elderly individuals in the ICU, 18.8% were robust, 28.6% had cancer, 68.1% had chronic organ failure, and 34.0% were frail; 41.3% qualified for multiple categories. Overall hospital mortality was 12.6%, with the lowest mortality for robust participants (9.7%). Participants with pre-ICU frailty had higher hospital mortality than those with the same pre-ICU health categories without frailty. (Adjusted odds ratios ranged from 1.27 (95% confidence interval (CI) 1.10-1.47) to 1.52 (95% CI = 1.35-1.63).) Robust hospital survivors had the lowest 3-year mortality (24.6%). Pre-ICU frailty conferred higher 3-year mortality than pre-ICU categories without frailty. (Adjusted hazard ratios ranged from 1.54 (95% CI = 1.45-1.64) to 1.84 (95% CI = 1.70-1.99).) Conclusion Critically ill elderly adults can be categorized according to pre-ICU health categories. These categories, particularly pre-ICU frailty, may be important for understanding risk of death during and after critical illness.

Original languageEnglish (US)
Pages (from-to)1121-1128
Number of pages8
JournalJournal of the American Geriatrics Society
Volume63
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Medicare
Critical Illness
Intensive Care Units
Mortality
Confidence Intervals
Health
Hospital Mortality
Proportional Hazards Models
Survivors
Neoplasms
Cohort Studies
Retrospective Studies
Logistic Models
Odds Ratio

Keywords

  • aged
  • critical illness
  • frailty
  • Medicare
  • prognosis

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Medicine(all)

Cite this

Frailty before critical illness and mortality for elderly medicare beneficiaries. / Hope, Aluko A.; Gong, Michelle Ng; Guerra, Carmen; Wunsch, Hannah.

In: Journal of the American Geriatrics Society, Vol. 63, No. 6, 01.06.2015, p. 1121-1128.

Research output: Contribution to journalArticle

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abstract = "Objectives To estimate the effect of pre-intensive care unit (ICU) health categories on mortality during and after critical illness, focusing specifically on the effect of pre-ICU frailty on short- and long-term mortality. Design Retrospective cohort study. Setting Medicare claims data from 2004 to 2008. Participants A nationally representative sample of elderly Medicare beneficiaries admitted to an ICU in 2005. Measurements Participants were classified into four pre-ICU health categories (robust, cancer, chronic organ failure, frailty) using claims data from the year before admission, allowing for assignment to multiple categories. The association between pre-ICU health category and hospital and 3-year mortality was assessed using multivariable logistic regression and Cox proportional hazards models. Results Of 47,427 elderly individuals in the ICU, 18.8{\%} were robust, 28.6{\%} had cancer, 68.1{\%} had chronic organ failure, and 34.0{\%} were frail; 41.3{\%} qualified for multiple categories. Overall hospital mortality was 12.6{\%}, with the lowest mortality for robust participants (9.7{\%}). Participants with pre-ICU frailty had higher hospital mortality than those with the same pre-ICU health categories without frailty. (Adjusted odds ratios ranged from 1.27 (95{\%} confidence interval (CI) 1.10-1.47) to 1.52 (95{\%} CI = 1.35-1.63).) Robust hospital survivors had the lowest 3-year mortality (24.6{\%}). Pre-ICU frailty conferred higher 3-year mortality than pre-ICU categories without frailty. (Adjusted hazard ratios ranged from 1.54 (95{\%} CI = 1.45-1.64) to 1.84 (95{\%} CI = 1.70-1.99).) Conclusion Critically ill elderly adults can be categorized according to pre-ICU health categories. These categories, particularly pre-ICU frailty, may be important for understanding risk of death during and after critical illness.",
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N2 - Objectives To estimate the effect of pre-intensive care unit (ICU) health categories on mortality during and after critical illness, focusing specifically on the effect of pre-ICU frailty on short- and long-term mortality. Design Retrospective cohort study. Setting Medicare claims data from 2004 to 2008. Participants A nationally representative sample of elderly Medicare beneficiaries admitted to an ICU in 2005. Measurements Participants were classified into four pre-ICU health categories (robust, cancer, chronic organ failure, frailty) using claims data from the year before admission, allowing for assignment to multiple categories. The association between pre-ICU health category and hospital and 3-year mortality was assessed using multivariable logistic regression and Cox proportional hazards models. Results Of 47,427 elderly individuals in the ICU, 18.8% were robust, 28.6% had cancer, 68.1% had chronic organ failure, and 34.0% were frail; 41.3% qualified for multiple categories. Overall hospital mortality was 12.6%, with the lowest mortality for robust participants (9.7%). Participants with pre-ICU frailty had higher hospital mortality than those with the same pre-ICU health categories without frailty. (Adjusted odds ratios ranged from 1.27 (95% confidence interval (CI) 1.10-1.47) to 1.52 (95% CI = 1.35-1.63).) Robust hospital survivors had the lowest 3-year mortality (24.6%). Pre-ICU frailty conferred higher 3-year mortality than pre-ICU categories without frailty. (Adjusted hazard ratios ranged from 1.54 (95% CI = 1.45-1.64) to 1.84 (95% CI = 1.70-1.99).) Conclusion Critically ill elderly adults can be categorized according to pre-ICU health categories. These categories, particularly pre-ICU frailty, may be important for understanding risk of death during and after critical illness.

AB - Objectives To estimate the effect of pre-intensive care unit (ICU) health categories on mortality during and after critical illness, focusing specifically on the effect of pre-ICU frailty on short- and long-term mortality. Design Retrospective cohort study. Setting Medicare claims data from 2004 to 2008. Participants A nationally representative sample of elderly Medicare beneficiaries admitted to an ICU in 2005. Measurements Participants were classified into four pre-ICU health categories (robust, cancer, chronic organ failure, frailty) using claims data from the year before admission, allowing for assignment to multiple categories. The association between pre-ICU health category and hospital and 3-year mortality was assessed using multivariable logistic regression and Cox proportional hazards models. Results Of 47,427 elderly individuals in the ICU, 18.8% were robust, 28.6% had cancer, 68.1% had chronic organ failure, and 34.0% were frail; 41.3% qualified for multiple categories. Overall hospital mortality was 12.6%, with the lowest mortality for robust participants (9.7%). Participants with pre-ICU frailty had higher hospital mortality than those with the same pre-ICU health categories without frailty. (Adjusted odds ratios ranged from 1.27 (95% confidence interval (CI) 1.10-1.47) to 1.52 (95% CI = 1.35-1.63).) Robust hospital survivors had the lowest 3-year mortality (24.6%). Pre-ICU frailty conferred higher 3-year mortality than pre-ICU categories without frailty. (Adjusted hazard ratios ranged from 1.54 (95% CI = 1.45-1.64) to 1.84 (95% CI = 1.70-1.99).) Conclusion Critically ill elderly adults can be categorized according to pre-ICU health categories. These categories, particularly pre-ICU frailty, may be important for understanding risk of death during and after critical illness.

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