Early Post-Intensive Care Syndrome among Older Adult Sepsis Survivors Receiving Home Care.
Activities of Daily Living
Aftercare
/ methods
Aged
Cognition
Critical Care
/ methods
Disability Evaluation
Female
Geriatric Assessment
/ methods
Home Care Services
/ statistics & numerical data
Humans
Intensive Care Units
/ statistics & numerical data
Length of Stay
/ statistics & numerical data
Male
Outcome and Process Assessment, Health Care
Patient Discharge
/ statistics & numerical data
Physical Functional Performance
Risk Factors
Sepsis
/ complications
Survivors
/ psychology
United States
/ epidemiology
activities of daily living
cognitive dysfunction
critical care
home care services
mental health
post-intensive care syndrome
sepsis
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
27
07
2018
revised:
06
10
2018
accepted:
15
10
2018
pubmed:
1
12
2018
medline:
19
3
2020
entrez:
1
12
2018
Statut:
ppublish
Résumé
New or worsened disabilities in functional, cognitive, or mental health following an intensive care unit (ICU) stay are referred to as post-intensive care syndrome (PICS). PICS has not been described in older adults receiving home care. Our aim was to examine the relationship between length of ICU stay and PICS among older adults receiving home care. We expected that patients in the ICU for 3 days or longer would demonstrate significantly more disability in all three domains on follow-up than those not in the ICU. A secondary aim was to identify patient characteristics increasing the odds of disability. Retrospective cohort study. Hospitalization for sepsis in the United States. A total of 21 520 Medicare patients receiving home care and reassessed a median of 1 day (interquartile range 1-2 d) after hospital discharge. PICS was defined as a decline or worsening in one or more of 16 indicators tested before and after hospitalization using OASIS (Home Health Outcome and Assessment Information Set) and Medicare claims data. The sample was predominantly female and white. All had sepsis, and most (81.8%) had severe sepsis. In adjusted models, an ICU stay of 3 days or longer, compared with no ICU stay, increased the odds of physical disability. Overall, the declines were modest and found in specific activities of daily living (16% for feeding and lower body dressing to 26% for oral medicine management). No changes were identified in cognition or mental health. Significant determinants of new or worsened physical disabilities were sepsis severity, older age, depression, frailty, and dementia. Older adults receiving home care who develop sepsis and are in an ICU for 3 days or longer are likely to develop new or worsened physical disabilities. Whether these disabilities remain after the early postdischarge phase requires further study. J Am Geriatr Soc 67:520-526, 2019.
Sections du résumé
BACKGROUND/OBJECTIVES
New or worsened disabilities in functional, cognitive, or mental health following an intensive care unit (ICU) stay are referred to as post-intensive care syndrome (PICS). PICS has not been described in older adults receiving home care. Our aim was to examine the relationship between length of ICU stay and PICS among older adults receiving home care. We expected that patients in the ICU for 3 days or longer would demonstrate significantly more disability in all three domains on follow-up than those not in the ICU. A secondary aim was to identify patient characteristics increasing the odds of disability.
DESIGN
Retrospective cohort study.
SETTING
Hospitalization for sepsis in the United States.
PARTICIPANTS
A total of 21 520 Medicare patients receiving home care and reassessed a median of 1 day (interquartile range 1-2 d) after hospital discharge.
MEASUREMENTS
PICS was defined as a decline or worsening in one or more of 16 indicators tested before and after hospitalization using OASIS (Home Health Outcome and Assessment Information Set) and Medicare claims data.
RESULTS
The sample was predominantly female and white. All had sepsis, and most (81.8%) had severe sepsis. In adjusted models, an ICU stay of 3 days or longer, compared with no ICU stay, increased the odds of physical disability. Overall, the declines were modest and found in specific activities of daily living (16% for feeding and lower body dressing to 26% for oral medicine management). No changes were identified in cognition or mental health. Significant determinants of new or worsened physical disabilities were sepsis severity, older age, depression, frailty, and dementia.
CONCLUSION
Older adults receiving home care who develop sepsis and are in an ICU for 3 days or longer are likely to develop new or worsened physical disabilities. Whether these disabilities remain after the early postdischarge phase requires further study. J Am Geriatr Soc 67:520-526, 2019.
Identifiants
pubmed: 30500988
doi: 10.1111/jgs.15691
pmc: PMC6402981
mid: NIHMS995482
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
520-526Subventions
Organisme : NINR NIH HHS
ID : R01 NR016014
Pays : United States
Informations de copyright
© 2018 The American Geriatrics Society.
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