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.

In order to evaluate changes in the functional autonomy of elderly patients after a stay in a medical intensive care unit (ICU), and the impact of post-ICU management in geriatric ward, we included in a randomized controlled trial 45 patients aged>or=75 years. They were assessed for functional autonomy before ICU stay, just after ICU discharge, just after hospital discharge, and 6 months later. The patients were randomly divided into two post-ICU management groups: "geriatric ward" and "standard care". Autonomy was usually recovered rapidly, but the degree of recovery depended on the patient's previous autonomy (p<0.0001). At the last assessment, 41% of the patients had recovered their previous autonomy. The mean Barthel indexes were 81.5+/-30.4 in the geriatric management arm and 70.5+/-33.4 in the standard management arm (p=0.4). The study was prematurely ended due to insufficient recruitment flow. These results underline the rapid loss of autonomy after a stay in a medical ICU. Early specific intervention to improve the autonomy of elderly patients seems an attractive solution that could be assessed by randomized controlled trial. Above all, our results should also serve as a basis for further controlled randomized studies in this setting.