de Rooij Sophia E, Abu-Hanna Ameen, Levi Marcel, de Jonge Evert
Department of Geriatrics, Academic Medical Center, University of Amsterdam, Amsterdam.
Crit Care. 2005 Aug;9(4):R307-14. doi: 10.1186/cc3536. Epub 2005 May 17.
Advanced age is thought to be associated with increased mortality in critically ill patients. This report reviews available data on factors that determine outcome, on the value of prognostic models, and on preferences regarding life-sustaining treatments in (very) elderly intensive care unit (ICU) patients.
We searched the Medline database (January 1966 to January 2005) for English language articles. Selected articles were cross-checked for other relevant publications.
Mortality rates are higher in elderly ICU patients than in younger patients. However, it is not age per se but associated factors, such as severity of illness and premorbid functional status, that appear to be responsible for the poorer prognosis. Patients' preferences regarding life-sustaining treatments are importantly influenced by the likelihood of a beneficial outcome. Commonly used prognostic models have not been calibrated for use in the very elderly. Furthermore, they do not address long-term survival and functional outcome.
We advocate the development of new prognostic models, validated in elderly ICU patients, that predict not only survival but also functional and cognitive status after discharge. Such a model may support informed decision making with respect to patients' preferences.
高龄被认为与危重症患者死亡率增加相关。本报告回顾了关于决定预后的因素、预后模型的价值以及（极）老年重症监护病房（ICU）患者对维持生命治疗的偏好的现有数据。
我们检索了Medline数据库（1966年1月至2005年1月）中的英文文章。对所选文章交叉核对其他相关出版物。
老年ICU患者的死亡率高于年轻患者。然而，似乎并非年龄本身，而是诸如疾病严重程度和病前功能状态等相关因素导致了较差的预后。患者对维持生命治疗的偏好受有益结果可能性的重要影响。常用的预后模型尚未针对极老年人进行校准。此外，它们未涉及长期生存和功能结局。
我们主张开发在老年ICU患者中得到验证的新预后模型，该模型不仅能预测生存，还能预测出院后的功能和认知状态。这样的模型可能有助于就患者偏好做出明智的决策。
