Aging Options

Lifestyle and ICU outcomes linked

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If you are elderly and disabled, stay out of the hospital’s intensive care unit (ICU).  It’s expensive for one thing and your health is likely to decline sharply after an ICU stay.  That’s not to say don’t go in at all but be aware, the less disabled you are, the better you’ll survive the stay, which is a really good argument for protecting your health with everything you can.  A study that looked at 300 patients over the age of 70 who had at least one ICU stay found that their health outcomes depended sharply upon their functional ability at the time of their stay.

Longer hospital stays and using a mechanical ventilator were linked to a greater risk of death within one year and that risk shared the same order of magnitude as a patient’s functional ability.

To be classified as minimally disabled, a person needed to be able to perform all or almost all of 13 functional tasks without help.  Mild to moderately disabled needed help with three tasks and those with severe disability averaged only four functional activities.

The need for assistance with Activities of Daily Living (ADLs) served as a predictor of 30-day and 1-year survival rates and showed that individuals who survived their ICU experience experienced higher rates of disability in the following year.  Those that entered the ICU with severe disability were at more than 3 times the risk for dying by 1 year as those with minimal to mild disability.  Even those with minimally to mild disability showed significantly worse disability following their discharge from the ICU.

This isn’t just a call to arms for the doctors and nurses working with older adults to think beyond the illness that brought the individual to the ICU in the first place and to consider the needs of that patient and the patient’s caregiver at discharge.  It’s also a wakeup call to what real expectations family members and caregivers might have for the medical outcomes after the ICU and to consider what needs to be different.

For at least one idea about how to keep disability at bay, please see this week’s story on How 10,000 steps a day and a smaller plate can save you money.

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