Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (S.J., L.E.F.).
Program on Aging, Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (T.E.M., J.R.O., L.L.).
Ann Intern Med. 2022 May;175(5):644-655. doi: 10.7326/M21-3086. Epub 2022 Mar 8.
Older adults admitted to an intensive care unit (ICU) are at risk for developing impairments in function, cognition, and mental health. It is not known whether socioeconomically disadvantaged older persons are at greater risk for these impairments than their less vulnerable counterparts.
To evaluate the association between socioeconomic disadvantage and decline in function, cognition, and mental health among older survivors of an ICU hospitalization.
Retrospective analysis of a longitudinal cohort study.
Community-dwelling older adults in the National Health and Aging Trends Study (NHATS).
Participants with ICU hospitalizations between 2011 and 2017.
Socioeconomic disadvantage was assessed as dual-eligible Medicare-Medicaid status. The outcome of function was defined as the count of disabilities in 7 activities of daily living and mobility tasks, the cognitive outcome as the transition from no or possible to probable dementia, and the mental health outcome as the Patient Health Questionnaire-4 score in the NHATS interview after ICU hospitalization. The analytic sample included 641 ICU hospitalizations for function, 458 for cognition, and 519 for mental health.
After accounting for sociodemographic and clinical characteristics, dual eligibility was associated with a 28% increase in disability after ICU hospitalization (incidence rate ratio, 1.28; 95% CI, 1.00 to 1.64); and nearly 10-fold greater odds of transitioning to probable dementia (odds ratio, 9.79; 95% CI, 3.46 to 27.65). Dual eligibility was not associated with symptoms of depression and anxiety after ICU hospitalization (incidence rate ratio, 1.33; 95% CI, 0.99 to 1.79).
Administrative data, variability in timing of baseline and outcome assessments, proxy selection.
Dual-eligible older persons are at greater risk for decline in function and cognition after an ICU hospitalization than their more advantaged counterparts. This finding highlights the need to prioritize low-income seniors in rehabilitation and recovery efforts after critical illness and warrants investigation into factors leading to this disparity.
National Institute on Aging.
入住重症监护病房（ICU）的老年人存在功能、认知和心理健康受损的风险。目前尚不清楚社会经济地位较低的老年人是否比他们的弱势群体更容易出现这些损伤。
评估 ICU 住院后老年人的社会经济劣势与功能、认知和心理健康下降之间的关系。
对纵向队列研究的回顾性分析。
国家健康老龄化趋势研究（NHATS）中的社区居住老年人。
2011 年至 2017 年期间 ICU 住院的参与者。
社会经济劣势评估为双重合格的医疗保险-医疗补助状况。功能结果定义为日常生活活动和移动任务 7 项残疾的计数，认知结果定义为从无或可能转变为可能痴呆，心理健康结果定义为 ICU 住院后 NHATS 访谈中的患者健康问卷-4 评分。分析样本包括 641 例 ICU 功能住院、458 例认知住院和 519 例心理健康住院。
在考虑了社会人口统计学和临床特征后，双重合格与 ICU 住院后残疾增加 28%相关（发病率比，1.28；95%置信区间，1.00 至 1.64）；并且几乎有 10 倍的可能性转变为可能的痴呆（比值比，9.79；95%置信区间，3.46 至 27.65）。双重合格与 ICU 住院后抑郁和焦虑症状无关（发病率比，1.33；95%置信区间，0.99 至 1.79）。
行政数据、基线和结果评估时间的可变性、代理选择。
与社会经济地位较高的同龄人相比，双重合格的老年人在 ICU 住院后功能和认知下降的风险更高。这一发现强调了在危重病后需要优先考虑低收入老年人的康复和恢复努力，并需要调查导致这一差异的因素。
美国国家老龄化研究所。
