2.50
Hdl Handle:
http://hdl.handle.net/10755/149173
Type:
Presentation
Title:
Exploring Outcomes After Critical Illness in the Elderly
Abstract:
Exploring Outcomes After Critical Illness in the Elderly
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Kleinpell, Ruth, PhD
P.I. Institution Name:Rush University
Title:Associate Professor
Objective: The objectives of this study were to explore and compare the impact of Intensive Care Unit (ICU) treatment on health and functional status outcomes for elderly and middle aged patients at hospital discharge and at 1, 3, 6, and 12 months after discharge. A secondary purpose was to evaluate the adequacy of discharge planning and perceptions of discharge readiness for critically ill elderly patients. Design: Longitudinal prospective panel research design with in-hospital and mailed questionnaires. Sample: 199 ICU patients aged 45 to 86 (Mean = 63, SD=10), 55% male, 45% female. Middle aged subjects (age 45-64, n=72) were compared to elderly subjects (age 65+, n=127). Setting: Four ICU settings at two Midwestern university-affiliated medical centers. Variables: Functional status, health status, discharge planning, perception of discharge readiness, social support. Measures: Medical Outcomes Study SF-36; Perception of Health Rating; Acute Physiology, Age, and Chronic Health Evaluation III (APACHE III); Discharge Adequacy Rating Form; Social Support in the Elderly Scale. Findings: Average hospital length of stay was 9 days (SD=6) and average ICU length of stay was 3 days (SD=3). Severity of illness, measured with APACHE III, averaged 48.39 (SD=15.5). No differences were found between middle aged and elderly subjects for length of stay or severity of illness. Functional status, as measured with the SF-36 did change over time, with physical functioning, social functioning, and mental health subscale scores increasing over time, while general health remained unchanged over time. Repeated measures analysis of variance revealed no difference between SF-36 subscale score changes over time between groups (p=.06 to .649). Regression analysis demonstrated that severity of illness best predicted mean physical functioning, with higher APACHE III scores associated with lower physical functioning (R2 = .034, p=.037). Higher severity of illness was also associated with lower general health (R2 = 0.44, p=0.13). Social support did not differ between groups (Wilks' Lambda=.982, df=4,150, p=.603), and there was no relationship between age and social support (r=-.19 to .224). Discharge planning was documented for only 57% of subjects and 35% of elderly subjects reported they were somewhat or not at all ready for discharge. One month after discharge from the hospital, 62% reported concern for managing their care at home and 37% felt they were not adequately prepared for discharge. Elderly patients reported knowing less about the purpose of medications and knowing danger signs to watch for after discharge (p=.038 and .036, respectively). Conclusions: Severity of illness, rather than age, influenced functional and health status outcomes for critically ill patients. Functional status did change over time after ICU hospitalization, with physical functioning, social functioning, and mental health subscale scores increasing over time, while general health remained unchanged over time. Documented discharge planning was lacking for 43% of subjects and elderly subjects reported feeling inadequately prepared for discharge, with concerns about managing their care at home. Better discharge planning is needed for critically ill elderly patients. Implications: Discharge planning and monitoring of outcomes for elderly patients after critical illness remains an important component in ensuring health care for this growing segment of the population. Phase II, a randomized clinical trial of an early discharge planning intervention for critically ill elderly patients is currently being conducted.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleExploring Outcomes After Critical Illness in the Elderlyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/149173-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Exploring Outcomes After Critical Illness in the Elderly</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Kleinpell, Ruth, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Rush University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">rkleinpell@rushu.rush.du</td></tr><tr><td colspan="2" class="item-abstract">Objective: The objectives of this study were to explore and compare the impact of Intensive Care Unit (ICU) treatment on health and functional status outcomes for elderly and middle aged patients at hospital discharge and at 1, 3, 6, and 12 months after discharge. A secondary purpose was to evaluate the adequacy of discharge planning and perceptions of discharge readiness for critically ill elderly patients. Design: Longitudinal prospective panel research design with in-hospital and mailed questionnaires. Sample: 199 ICU patients aged 45 to 86 (Mean = 63, SD=10), 55% male, 45% female. Middle aged subjects (age 45-64, n=72) were compared to elderly subjects (age 65+, n=127). Setting: Four ICU settings at two Midwestern university-affiliated medical centers. Variables: Functional status, health status, discharge planning, perception of discharge readiness, social support. Measures: Medical Outcomes Study SF-36; Perception of Health Rating; Acute Physiology, Age, and Chronic Health Evaluation III (APACHE III); Discharge Adequacy Rating Form; Social Support in the Elderly Scale. Findings: Average hospital length of stay was 9 days (SD=6) and average ICU length of stay was 3 days (SD=3). Severity of illness, measured with APACHE III, averaged 48.39 (SD=15.5). No differences were found between middle aged and elderly subjects for length of stay or severity of illness. Functional status, as measured with the SF-36 did change over time, with physical functioning, social functioning, and mental health subscale scores increasing over time, while general health remained unchanged over time. Repeated measures analysis of variance revealed no difference between SF-36 subscale score changes over time between groups (p=.06 to .649). Regression analysis demonstrated that severity of illness best predicted mean physical functioning, with higher APACHE III scores associated with lower physical functioning (R2 = .034, p=.037). Higher severity of illness was also associated with lower general health (R2 = 0.44, p=0.13). Social support did not differ between groups (Wilks' Lambda=.982, df=4,150, p=.603), and there was no relationship between age and social support (r=-.19 to .224). Discharge planning was documented for only 57% of subjects and 35% of elderly subjects reported they were somewhat or not at all ready for discharge. One month after discharge from the hospital, 62% reported concern for managing their care at home and 37% felt they were not adequately prepared for discharge. Elderly patients reported knowing less about the purpose of medications and knowing danger signs to watch for after discharge (p=.038 and .036, respectively). Conclusions: Severity of illness, rather than age, influenced functional and health status outcomes for critically ill patients. Functional status did change over time after ICU hospitalization, with physical functioning, social functioning, and mental health subscale scores increasing over time, while general health remained unchanged over time. Documented discharge planning was lacking for 43% of subjects and elderly subjects reported feeling inadequately prepared for discharge, with concerns about managing their care at home. Better discharge planning is needed for critically ill elderly patients. Implications: Discharge planning and monitoring of outcomes for elderly patients after critical illness remains an important component in ensuring health care for this growing segment of the population. Phase II, a randomized clinical trial of an early discharge planning intervention for critically ill elderly patients is currently being conducted.</td></tr></table>en_GB
dc.date.available2011-10-26T09:57:27Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:57:27Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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