Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK; Royal Infirmary of Edinburgh, Edinburgh, UK.
Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK; Royal Infirmary of Edinburgh, Edinburgh, UK.
Lancet. 2015 Feb 26;385 Suppl 1:S33. doi: 10.1016/S0140-6736(15)60348-8.
As the general population ages and life expectancy increases, health-care use by elderly people increases, including intensive care. Rationing and variation of access are ethically and politically challenging. We aimed to characterise the population-based incidence of intensive care unit (ICU) admissions of elderly people in Scotland; compare ICU admission and mortality between elderly and younger populations; and compare treatment intensity between these groups.
We extracted complete, national 6-year cohort Scottish ICU admissions (Jan 1, 2005, to Dec 31, 2010) from the Scottish Intensive Care Society Audit Group database, which we linked to hospital Scottish Morbidity Record (SMR01) and death records. Annual incidence of ICU admissions of people aged 80 years or older was standardised for sex and socioeconomic status to the standard Scottish population (≥80 years) 2005-10. We compared mortality of elderly and younger people (<65 years) using the log-rank test.
During 2005-10, 47 779 people were admitted to ICU (4561 patients ≥80 years [9·5%, 35·0/10 000 population], 26 784 patients <65 years [56·1%, 13·2/10 000]). Incidence of ICU admissions of elderly people fell from 36·6/10 000 population (95%CI 34·0-39·2) in 2005 to 30·3/10 000 (28·0-32·5) in 2010. ICU mortality was higher in elderly than in younger people (26·4% vs 16·1%, p<0·0001) as was 6-year mortality (68·0% vs 34·5%, p<0·0001). 2110 (80%) of 2627 elderly survivors were discharged home (younger 92%, 19 221/20 902), with a further 373 (14·2%) given rehabilitation (younger 1063, 5·1%) (χ(2)=525, p<0·0001). Age was an independent predictor of mortality (odds ratio 1·46, 95% CI 1·23-1·73, p<0·0001) after adjustment for confounders. In the pneumonia subgroup (elderly 294, younger 2167), mean acute physiology scores were similar (17·0 [SD 6·4] vs 17·6 [6·6]), organ support was higher in the elderly patients (77·0% vs 68·1%, p<0·0001), and median ICU length of stay was lower (6 days [IQR 3-13] vs 8 [3-16], p<0·0001).
This study has shown that, by contrast with previously published research, admission rates of elderly people in Scotland fell between 2005 and 2010. Only the fittest elderly individuals were admitted to ICU, where initially they received a higher intensity of treatment than did younger patients; however, duration of ICU stay was shorter. Mortality rates were high, and age was an independent predictor of mortality.
Funding assistance for AD's MPH from Scottish Intensive Care Society, Scottish Society of Anaesthetists, Edinburgh Anaesthetics Research and Education Fund.
随着人口老龄化和预期寿命的延长，老年人对医疗保健的需求增加，包括重症监护。在伦理和政治方面，对资源的分配和获取存在挑战。本研究旨在描述苏格兰基于人群的老年重症监护病房（ICU）入院率；比较老年和年轻人群的 ICU 入院率和死亡率；并比较这些人群的治疗强度。
我们从苏格兰重症监护学会审计组数据库中提取了完整的、全国性的 6 年队列苏格兰 ICU 入院数据（2005 年 1 月 1 日至 2010 年 12 月 31 日），并将其与医院苏格兰发病率记录（SMR01）和死亡记录进行了关联。将 80 岁及以上人群的 ICU 入院率按性别和社会经济状况标准化，以匹配 2005-10 年的标准苏格兰人口（≥80 岁）。使用对数秩检验比较老年和年轻人群（<65 岁）的死亡率。
在 2005-10 年期间，共有 47779 人入住 ICU（4561 名患者≥80 岁[9.5%，35.0/10000 人口]，26784 名患者<65 岁[56.1%，13.2/10000 人口]）。苏格兰老年人 ICU 入院率从 2005 年的 36.6/10000 人口（95%CI 34.0-39.2）降至 2010 年的 30.3/10000（28.0-32.5）。与年轻患者相比，老年患者的 ICU 死亡率（26.4% vs 16.1%，p<0.0001）和 6 年死亡率（68.0% vs 34.5%，p<0.0001）更高。在 2627 名存活的老年患者中，有 2110 名（80%）出院回家（年轻患者为 92%，19221 名/20902 名），373 名（14.2%）接受了康复治疗（年轻患者为 1063 名，5.1%）（χ(2)=525，p<0.0001）。在校正混杂因素后，年龄是死亡率的独立预测因素（优势比 1.46，95%CI 1.23-1.73，p<0.0001）。在肺炎亚组（老年患者 294 名，年轻患者 2167 名）中，急性生理学评分的平均值相似（17.0[标准差 6.4] vs 17.6[6.6]），老年患者的器官支持更高（77.0% vs 68.1%，p<0.0001），ICU 住院时间中位数更短（6 天[IQR 3-13] vs 8 天[3-16]，p<0.0001）。
本研究表明，与之前发表的研究相比，苏格兰老年人的入院率在 2005 年至 2010 年间有所下降。只有最健康的老年患者被收入 ICU，他们最初接受的治疗强度高于年轻患者；然而，ICU 住院时间较短。死亡率很高，年龄是死亡率的独立预测因素。
AD 的 MPH 得到了苏格兰重症监护学会、苏格兰麻醉师学会、爱丁堡麻醉学研究和教育基金的资助。
