Study Shows Need for Geriatric Principles in Critical Care Medicine

MODEL RELEASED. Female doctor holding patients hand.
A recent study quantifies changing rates of disability, dementia, frailty, and multimorbidity among older adults in the ICU from1998 to 2015.

There was an increased prevalence of geriatric conditions — that is, preexisting disability, frailty, and multimorbidity — among older patients admitted to the intensive care unit (ICU) between 1998 and 2015, according to results of a study published in the journal Chest.

Investigators for the current study sought to explore how changes in disability, dementia, frailty, and multimorbidity in older adults admitted to an ICU have evolved from 1985 to 2015. These geriatric outcomes of interest were analyzed using data from a nationally representative survey of older adults, the Health and Retirement Study. Investigators identified survey respondents aged 65 years and over who had been admitted to an ICU during the study period. Disability was defined as the need for assistance with at least 1 activity of daily living. Dementia was evaluated by using cognitive and functional measures. Frailty comprised deficits in at least 2 domains (ie, physical, nutritive, cognitive, or sensory function). Multimorbidity denoted at least 3 self-reported chronic diseases. 

Among a total of 6084 patients admitted to an ICU, the age at admission increased from 77.6 years (95% CI, 76.7-78.4) in 1998 to 78.7 years (95% CI, 77.5-79.8) in 2015

(P <.001 for trend). The adjusted percentage of ICU admissions with a preexisting disability increased significantly from 15.5% (95% CI, 12.1-18.8%) in 1998 to 24.0% (95% CI, 18.5-29.6% in 2015 (P =.001). No significant changes were reported in the rates of dementia (P =.21). Rates of frailty rose significantly from 36.6% (95% CI, 30.9-42.3%) in 1998 to 45.0% (95% CI, 39.7-50.2%) in 2015 (P =.04). Additionally, multimorbidity increased significantly from 54.4% (95% CI, 49.2-59.7%) in 1998 to 71.8% (95% CI, 66.3-77.2%) in 2015 (P <.001).

Cardiac diseases were the most common reasons for hospitalization and were also the most common primary diagnosis listed for a given hospitalization. The study cohort consisted of patients who self-reported as non-Hispanic or White (76.7%), non-Hispanic Black (14.0%) and Hispanic (7.6%). Across all of the years evaluated in the study, 61.4% of patients had multimorbidity and 84.2% had at least 2 chronic diseases.

The investigators concluded that the findings from the current study underscore the urgent need to integrate geriatric principles into critical care medicine. Additional research is warranted, to examine whether early interventions that emphasize physical, cognitive, mental health, delirium prevention, advanced care planning, and rehabilitation, and are individualized to critically ill elderly patients with preexisting geriatric conditions, might improve ICU outcomes in this population.

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  


Cobert J, Jeon SY,  Boscardin J, et al. Trends in geriatric conditions among older adults admitted to US intensive care units between 1998-2015. Chest. Published online January 10, 2022. doi:10.1016/j.chest.2021.12.658