Author/Authors :
Kim, Junghyun Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Lee, Jungkyu Department of Internal Medicine - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Choi, Sunmi Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Lee, Jinwoo Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Park, Young Sik Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Lee, Chang-Hoon Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Yim, Jae-Joon Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Yoo, Chul-Gyu Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Kim, Young Whan Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Han, Sung Koo Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea , Lee, Sang-Min Department of Internal Medicine - Seoul National University Hospital - Seoul Metropolitan Government-Seoul National University Boramae Medical Center - Seoul, Korea
Abstract :
Background: The number of elderly patients admitted to intensive care units (ICUs) is growing with the increasing proportion of
elderly persons in the Korean general population. It is often difficult to make decisions about ICU care for elderly patients, especially
when they are in their 90s. Data regarding the proportion of elderly patients in their 90s along with their clinical characteristics in ICU
are scarce.
Methods: The records of Korean patients ≥ 90 years old who were admitted to the medical ICU in a tertiary referral hospital between
January 2005 and December 2014 were retrospectively reviewed. We compared the trend in ICU use and characteristics of these elderly
patients between 2005-2009 and 2010-2014.
Results: Among 6,186 referred patients, 55 aged ≥ 90 years were admitted to the medical ICU from 2005 to 2014. About 58.2% of
these patients were male, and their mean age was 92.7 years. Their median Charlson comorbidity index score was 2 (IQR 1-3) and their
mean APACHE II score was 25.0 (IQR 19.0-34.0). The most common reason for ICU care was acute respiratory failure. There were no differences
in the survival rates between the earlier and more recent cohorts. However, after excluding patients who had specified “do
not resuscitate” (DNR), the more recent group showed a significantly higher survival rate (53.8% mortality for the earlier group and
0% mortality for the recent group). Among the survivors, over half were discharged to their homes. More patients in the recent cohort
(n=26 [78.8%]) specified DNR than in the earlier cohort (n=7 [35.0%], p=0.004). The number and proportion of patients ≥ 90 years old
among patients using ICU during the 2005-2014 study period did not differ.
Conclusions: The use of ICU care by elderly patients ≥ 90 years old was consistent from 2005-2014. The overall mortality rate tended to
decrease, but this was not statistically significant. However, the proportion of patients specifying DNR was higher among more recent
patients, and the recent group showed an even better survivorship after sensitivity analysis excluded patients specifying DNR.
