Survival of elderly patients in intensive care units. Should they be admitted to these units?

Background: An important increase in health care costs has occurred lately, determined in part by the expenses of intensive care units. An important proportion of beds in these units are occupied by elders, with high costs and dubious results. Aim: To study the survival of elderly patients in intensive care units to shed light on the question if these patients should be admitted to these facilities. Material and methods: We retrospectively analyzed the mortality of 443 patients older than 65 years old, admitted to an intensive care unit between 1993 and 1994. The mortality was compared with that of 334 younger patients admitted in the same period. Severity of disease was determined using admission APACHE II score. Results: Older patients had a higher admission APACHE score than younger subjects (18.4 +/- 8.4 and 14.5 +/- 8.7 respectively, p < 0.001). Mortality during the intensive care unit stay was similar in older and younger patients (18.5 and 14.4%, respectively). Hospital mortality was also similar (22.4 and 25.9%, respectively). Older patients had a higher frequency of chronic diseases and degree of functional impairment. Mortality rates for different diseases were also similar in older and younger patients. Conclusions: Older age was not associated with a higher mortality during intensive care unit stay. Prognosis is determined by the admission severity score and the number of concomitant chronic diseases.