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Review article: Biomedical intelligence

Vol. 142 No. 3738 (2012)

Prognosis and quality of life of elderly patients after intensive care

  • Marco Conti
  • Paolo Merlani
  • Bara Ricou
Cite this as:
Swiss Med Wkly. 2012;142:w13671


Ageing of the world’s population raises important questions about the utilisation of the health care system. It is not clear how much should be invested in the last years of life whereas the costs are known to increase in parallel. Since intensive care units (ICU) are costly with highly specialised personnel, it seems of paramount importance that they would be used efficiently. Indeed, in the present context of predicted shortage of physicians in Switzerland, society and politics will need evidence that the care provided by ICUs is appropriate. There is no explicit limitation of care in any country according to age and nonagerians are admitted nowadays into ICUs with critical illness.

This review article will address the question of elderly patients in ICU and their outcome. Outcome does not imply surviving ICU but only later during the hospital stay and after discharge. Furthermore, we emphasise the need of examining not solely the hospital survival but the quality of life of the patients when they return to their real life. The fundamental questions are actually “Do they go back to life?” “What is life for elderly people?” These questions lead to more basic questions such as “Are they able to go back home or are they institutionalised? How is their quality of life and functional status after ICU?”.

We tried to address these questions through the existing literature and our experience while caring for these particular patients. Some clues on the prognostic factors related to their outcome are reported.


  1. Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA. 2011;306(24):2694–703.
  2. Halpern SD. Perceived inappropriateness of care in the ICU: what to make of the clinician’s perspective? JAMA. [Comment Editorial Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.]. 2011;306(24):2725–6.
  3. Merlani P, Verdon M, Businger A, Domenighetti G, Pargger H, Ricou B. Burnout in ICU caregivers: a multicenter study of factors associated to centers. Am J Respir Crit Care Med. 2011;184(10):1140–6.
  4. Quetelet A. Sur l’Homme et le développement de ses Facultés. Bruxelles: L. Hauman; 1836.
  5. Kirk H. Geriatric medicine and the categorisation of old age; the historical linkage. Ageing & Society. 1992;12(04):483–97.
  6. Hennessy D, Juzwishin K, Yergens D, Noseworthy T, Doig C. Outcomes of elderly survivors of intensive care: a review of the literature. Chest. 2005;127(5):1764–74.
  7. Chelluri L, Pinsky MR, Grenvik AN. Outcome of intensive care of the “oldest-old” critically ill patients. Crit Care Med. 1992;20(6):757–61.
  8. Djaiani G, Ridley S. Outcome of intensive care in the elderly. Anaesthesia. 1997;52(12):1130–6.
  9. Kaarlola A, Tallgren M, Pettila V. Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med. 2006;34(8):2120–6.
  10. Conti M, Merlani P, Eckert P. Patient âgé aux soins intensifs. Rev Med suisse. 2009;5(229):2494–8.
  11. Ricou B, Merlani P. What limits for acute care in the elderly? Curr Opin Anaesthesiol. 2008;21(3):380–5.
  12. Metnitz PG, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3 – from evaluation of the patient to evaluation of the intensive care unit. Part 1: objectives, methods and cohort description. Intensive Care Med. 2005;31(10):1336–44.
  13. Rosenthal GE, Kaboli PJ, Barnett MJ, Sirio CA. Age and the risk of in-hospital death: insights from a multihospital study of intensive care patients. J Am Geriatr Soc. 2002;50(7):1205–12.
  14. Bagshaw SM, Webb SA, Delaney A, George C, Pilcher D, Hart GK, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care. 2009;13(2):R45.
  15. Lerolle N, Trinquart L, Bornstain C, Tadie JM, Imbert A, Diehl JL, et al. Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade*. Crit Care Med. 2009 Jul 23.
  16. Ihra GC, Lehberger J, Hochrieser H, Bauer P, Schmutz R, Metnitz B, et al. Development of demographics and outcome of very old critically ill patients admitted to intensive care units. Intensive Care Med. 2012;38(4):620–6.
  17. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J, Jr. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284(21):2762–70.
  18. Pronovost PJ, Waters H, Dorman T. Impact of critical care physician workforce for intensive care unit physician staffing. Curr Opin Crit Care. 2001;7(6):456–9.
  19. Bundesamt für Statistik (BAFS). [Accessed 10th may 2012]; Available from:
  20. Merlani P, Conti M, Ricou B. After ICU. ICU Management. 2011;11(3):6–10.
  21. Castillo-Lorente E, Rivera-Fernandez R, Vazquez-Mata G. Limitation of therapeutic activity in elderly critically ill patients. Project for the Epidemiological Analysis of Critical Care Patients. Crit Care Med. 1997;25(10):1643–8.
  22. Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonghe B, Carlet J. Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med. 2000;28(10):3389–95.
  23. Laupland KB, Kirkpatrick AW, Kortbeek JB, Zuege DJ. Long-term mortality outcome associated with prolonged admission to the ICU. Chest. 2006;129(4):954–9.
  24. Hamel MB, Davis RB, Teno JM, Knaus WA, Lynn J, Harrell F, Jr., et al. Older age, aggressiveness of care, and survival for seriously ill, hospitalized adults. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med. 1999;131(10):721–8.
  25. Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med. 2003;29(12):2137–43.
  26. Williams TA, Dobb GJ, Finn JC, Webb SA. Long-term survival from intensive care: a review. Intensive Care Med. 2005;31(10):1306–15.
  27. Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B. Should elderly patients be admitted to the intensive care unit? Intensive Care Med. 2007;33(7):1252–62.
  28. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100(6):1619–36.
  29. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–63.
  30. Minne L, Ludikhuize J, de Jonge E, de Rooij S, Abu-Hanna A. Prognostic models for predicting mortality in elderly ICU patients: a systematic review. Intensive Care Med. 2011;37(8):1258–68.
  31. World Health Organization. Basic documents. 46th ed. Geneva: World Health Organization; 2007.
  32. What quality of life? The WHOQOL Group. World Health Organization Quality of Life Assessment. World Health Forum. 1996;17(4):354–6.
  33. Hayes JA, Black NA, Jenkinson C, Young JD, Rowan KM, Daly K, et al. Outcome measures for adult critical care: a systematic review. Health Technol Assess. 2000;4(24):1–111.
  34. Oeyen SG, Vandijck DM, Benoit DD, Annemans L, Decruyenaere JM. Quality of life after intensive care: a systematic review of the literature. Crit Care Med. 2010;38(12):2386–400.
  35. Chelluri L, Pinsky MR, Donahoe MP, Grenvik A. Long-term outcome of critically ill elderly patients requiring intensive care. JAMA. 1993;269(24):3119–23.
  36. Merlani P, Chenaud C, Mariotti N, Ricou B. Long-term outcome of elderly patients requiring intensive care admission for abdominal pathologies: survival and quality of life. Acta Anaesthesiol Scand. 2007;51(5):530–7.
  37. de Rooij SE, Govers AC, Korevaar JC, Giesbers AW, Levi M, de Jonge E. Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc. 2008;56(5):816–22.
  38. Tabah A, Philippart F, Timsit JF, Willems V, Francais A, Leplege A, et al. Quality of life in patients aged 80 or over after ICU discharge. Crit Care. 2010;14(1):R2.
  39. Carstensen LL, Fung HH, Charles ST. Socioemotional selectivity theory and the regulation of emotion in the second half of life. Motiv Emotion. 2003;27(2):103–23.
  40. Graf J, Koch M, Dujardin R, Kersten A, Janssens U. Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med. 2003;31(8):2163–9.
  41. Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, et al. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med. 2005;31(5):611–20.
  42. Garrouste-Orgeas M, Montuclard L, Timsit JF, Misset B, Christias M, Carlet J. Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes. Intensive Care Med. 2003;29(5):774–81.
  43. Luppa M, Luck T, Weyerer S, Konig HH, Brahler E, Riedel-Heller SG. Prediction of institutionalization in the elderly. A systematic review. Age Ageing. 2010;39(1):31–8.
  44. Campbell SE, Seymour DG, Primrose WR, Lynch JE, Dunstan E, Espallargues M, et al. A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project. Age Ageing. 2005;34(5):467–75.
  45. Ribbe MW, Ljunggren G, Steel K, Topinkova E, Hawes C, Ikegami N, et al. Nursing homes in 10 nations: a comparison between countries and settings. Age Ageing. [Comparative Study Research Support, Non-U.S. Gov’t]. 1997;26(Suppl 2):3–12.
  46. Anderson GF, Hussey PS. Population aging: a comparison among industrialized countries. Health Aff (Millwood). Comparative Study. 2000;19(3):191–203.
  47. Nierman DM, Schechter CB, Cannon LM, Meier DE. Outcome prediction model for very elderly critically ill patients. Crit Care Med. 2001;29(10):1853–9.
  48. Gehlbach BK, Salamanca VR, Levitt JE, Sachs GA, Sweeney MK, Pohlman AS, et al. Patient-related factors associated with hospital discharge to a care facility after critical illness. Am J Crit Care. 2011;20(5):378–86.
  49. Conti M, Friolet R, Eckert P, Merlani P. Home return 6 months after an intensive care unit admission for elderly patients. Acta Anaesthesiol Scand. 2011;55(4):387–93.
  50. Code civil suisse (Protection de l’adulte, droit des personnes et droit de la filiation). Modification du 19 décembre 2008. Available from: Accessed 13th may 2012.
  51. Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinova K, Lafabrie A, et al. Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med. 2009;180(9):853–60.
  52. Escher M, Perneger TV, Chevrolet JC. National questionnaire survey on what influences doctors’ decisions about admission to intensive care. BMJ. 2004;329(7463):425.
  53. Hubbard RE, Lyons RA, Woodhouse KW, Hillier SL, Wareham K, Ferguson B, et al. Absence of ageism in access to critical care: a cross-sectional study. Age Ageing. 2003;32(4):382–7.
  54. Iapichino G, Corbella D, Minelli C, Mills GH, Artigas A, Edbooke DL, et al. Reasons for refusal of admission to intensive care and impact on mortality. Intensive Care Med. 2010;36(10):1772–9.
  55. Sprung CL, Artigas A, Kesecioglu J, Pezzi A, Wiis J, Pirracchio R, et al. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly*. Crit Care Med. 2012;40(1):132–8.
  56. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, et al. End-of-life practices in European intensive care units: the Ethicus Study. JAMA. 2003;290(6):790–7.
  57. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274(20):1591–8.
  58. Hamel MB, Teno JM, Goldman L, Lynn J, Davis RB, Galanos AN, et al. Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Ann Intern Med. 1999;130(2):116–25.
  59. Boumendil A, Aegerter P, Guidet B. Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc. 2005;53(1):88–93.
  60. Reinikainen M, Uusaro A, Niskanen M, Ruokonen E. Intensive care of the elderly in Finland. Acta Anaesthesiol Scand. 2007;51(5):522–9.
  61. Sprung CL, Woodcock T, Sjokvist P, Ricou B, Bulow HH, Lippert A, et al. Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study. Intensive Care Med. 2008;34(2):271–7.
  62. Murphy DJ, Burrows D, Santilli S, Kemp AW, Tenner S, Kreling B, et al. The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation. N Engl J Med. 1994;330(8):545–9.
  63. Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346(14):1061–6.
  64. Mattimore TJ, Wenger NS, Desbiens NA, Teno JM, Hamel MB, Liu H, et al. Surrogate and physician understanding of patients’ preferences for living permanently in a nursing home. J Am Geriatr Soc. 1997;45(7):818–24.
  65. Coppola KM, Ditto PH, Danks JH, Smucker WD. Accuracy of primary care and hospital-based physicians’ predictions of elderly outpatients’ treatment preferences with and without advance directives. Arch Intern Med. 2001;161(3):431–40.
  66. Mendelsohn AB, Chelluri L. Interviews with intensive care unit survivors: assessing post-intensive care quality of life and patients’ preferences regarding intensive care and mechanical ventilation. Crit Care Med. 2003;31(5 Suppl):S400–6.
  67. Campion EW, Mulley AG, Goldstein RL, Barnett GO, Thibault GE. Medical intensive care for the elderly. A study of current use, costs, and outcomes. JAMA. 1981;246(18):2052–6.
  68. Mahul P, Perrot D, Tempelhoff G, Gaussorgues P, Jospe R, Ducreux JC, et al. Short- and long-term prognosis, functional outcome following ICU for elderly. Intensive Care Med. 1991;17(1):7–10.
  69. Kass JE, Castriotta RJ, Malakoff F. Intensive care unit outcome in the very elderly. Crit Care Med. 1992;20(12):1666–71.
  70. Rockwood K, Noseworthy TW, Gibney RT, Konopad E, Shustack A, Stollery D, et al. One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med. 1993;21(5):687–91.
  71. Bo M, Massaia M, Raspo S, Bosco F, Cena P, Molaschi M, et al. Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit. J Am Geriatr Soc. 2003;51(4):529–33.
  72. Boumendil A, Maury E, Reinhard I, Luquel L, Offenstadt G, Guidet B. Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med. 2004;30(4):647–54.
  73. Demoule A, Cracco C, Lefort Y, Ray P, Derenne JP, Similowski T. Patients aged 90 years or older in the intensive care unit. J Gerontol A Biol Sci Med Sci. 2005;60(1):129–32.
  74. de Rooij SE, Govers A, Korevaar JC, Abu-Hanna A, Levi M, de Jonge E. Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med. 2006;32(7):1039–44.
  75. Sacanella E, Perez-Castejon JM, Nicolas JM, Masanes F, Navarro M, Castro P, et al. Mortality in healthy elderly patients after ICU admission. Intensive Care Med. 2009;35(3):550–5.
  76. Rady MY, Johnson DJ. Hospital discharge to care facility: a patient-centered outcome for the evaluation of intensive care for octogenarians. Chest. 2004;126(5):1583–91.

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