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 language | English (US) |
|---|---|
| Pages (from-to) | 1121-1128 |
| Number of pages | 8 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 63 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2015 |
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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 journal › Article
}
TY - JOUR
T1 - Frailty before critical illness and mortality for elderly medicare beneficiaries
AU - Hope, Aluko A.
AU - Gong, Michelle Ng
AU - Guerra, Carmen
AU - Wunsch, Hannah
PY - 2015/6/1
Y1 - 2015/6/1
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.
KW - aged
KW - critical illness
KW - frailty
KW - Medicare
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=84931441185&partnerID=8YFLogxK
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U2 - 10.1111/jgs.13436
DO - 10.1111/jgs.13436
M3 - Article
VL - 63
SP - 1121
EP - 1128
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 6
ER -