Loss of autonomy among elderly patients after a stay in a medical intensive care unit (ICU): A randomized study of the benefit of transfer to a geriatric ward
Introduction
Fragile elderly people are at an increased risk of death and loss of autonomy, reflecting a lack of “physiological reserves” (Bergman et al., 2007). The apparent potential for recovery can affect the decision to admit an elderly person to an ICU (Boumendil et al., 2007). Geriatric wards have been shown to preserve patients’ autonomy (Stuck et al., 1993), but there are no studies of this issue in the early post-ICU period. We report preliminary results on changes in the physical, mental and social autonomy of patients more than 75 years old after a stay in an ICU, according to whether they were transferred to a dedicated geriatric ward or to a general ward.
Section snippets
Study design
We conducted a randomized controlled study with direct individual benefit designed to compare the benefit of specific geriatric management compared with standard management after a stay in an ICU among patients over 75 years of age. The study took place at a university hospital in Paris, France, between February 2003 and January 2005. The study was halted prematurely by the sponsor (Caissse Nationale d’Assurance Maladie—CNAM) because patient accrual was too slow (Fig. 1).
Patients
Patients aged at least
Study population
Forty-five patients were enrolled during the first 2 years of the study, whereas an accrual rate of 65 patients per year was expected. Fig. 1 shows the rate of patient accrual and the reasons for ineligibility. Unexpected reasons for ineligibility included the large number of patients requiring highly specialized care after their stay in the ICU; the number of patients living more than 50 km from the hospital; and language problems preventing the collection of informed consent (n = 66). Another 16
Discussion
This study of 45 patients aged at least 75 years shows that autonomy is usually recovered rapidly after discharge from an ICU, and that the degree of recovery depends on the level of autonomy prior to ICU admission.
Recruitment of acute-care elderly patients to this type of prospective study is notoriously difficult (Berkman et al., 2001). The accrual rate was slow in our study, owing to unexpected reasons for exclusion. The main problem was urgent patient transfer from the ICU (<24 h), and
Conclusion
Recovery of autonomy by elderly patients after a stay in an ICU seems to depend mainly on two factors: the level of autonomy prior to ICU admission, and the type of in-hospital care they receive after being discharged from the ICU. Transfer to a specifically designed geriatric ward rather than to a general ward should be an attractive way to reduce this loss of autonomy. This strategy should be clearly assessed in future randomized control trials. Our study could serve as a basis for further
Conflict of interest statement
None.
Acknowledgement
This research project was made possible through a financial grant allocated by the scientific committee of the Caissse Nationale d’Assurance Maladie (CNAM).
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