Characteristics and Outcomes of Nursing Home Residents Admitted to ICU: A Retrospective Cohort Study
CCCF ePoster library. Chaudhuri D. Nov 9, 2018; 233336
Dipayan Chaudhuri
Dipayan Chaudhuri
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Abstract
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Introduction: LTC facilities exist to deliver care to individuals who are unable to function in the community due to illness or disability. These individuals may subsequently be subjected to transfers to acute care that is burdensome, costly and unlikely to improve their quality of life or chance for survival. In this study, we sought to characterize residents of LTC facilities in Ontario, examine their rates of ICU stays, and evaluate their experience when admitted to ICU.

Methods: This prospective cohort study examined residents from LTC facilities who were transferred to hospital within 12 months of their incident care in this setting. We compared these residents with those who remained in LTC over the same period and examined their baseline characteristics, outcomes and location of death. This study was conducted at the Institute for Clinical Evaluative Sciences (ICES) and was approved by the research ethics board at Sunnybrook Health Sciences Centre and by the Ottawa Health Science Network Research Ethics Board.

Results:  In total, 85,520 individuals from LTC were included in the study. Of these residents, 35.2% (n=30,085) were admitted to hospital and 2.3% (n=1,979) were admitted to ICU within one-year of LTC entry. We show 60% of the patients from LTC admitted to ICU were over the age of 80. Approximately 25% of patients who were admitted to ICU from LTC were at least dependent or totally dependent for their IADLs. 34% of ICU patients admitted from LTC were diagnosed as having at least moderate cognitive impairment using the CPS. Among patients who were admitted to ICU, 54.7% died within one year. This number increased further for those who were admitted to ICU and were dependent for ADLs at baseline. Patients admitted to ICU had a nine times higher rate of dying in acute care when compared to patients who did not access acute care.

Conclusions: Our study is the first large, population-level study examining a cohort of patients in LTC and their associated outcomes in acute care, including ICU. Despite admission to ICU, those admitted experienced a markedly increased rate of in-hospital, short and long-term post-discharge mortality compared with those that do not access ICU.  To that end, we demonstrate almost half of patients admitted to ICU ended up dying in acute care; with a further 10 fold risk of dying in acute care, compared with their peers from LTC who do not enter acute care.

 


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