Nonadherence to geriatric-focused practices in older intensive care unit survivors
Am J Crit Care
© 2018 American Association of Critical-Care Nurses. Background Older adults account for more than half of all admissions to intensive care units; most remain alive at 1 year, but with long-term sequelae. Objective To explore geriatric-focused practices and associated outcomes in older intensive care survivors. Methods In a 1-year, retrospective, cohort study of patients admitted to the medical intensive care unit and subsequently transferred to the medicine service, adherence to geriatric-focused practices and associated clinical outcomes during intensive care were determined. Results A total of 179 patients (mean age, 80.5 years) met inclusion criteria. Nonadherence to geriatric-focused practices, including nothing by mouth (P = .004), exposure to benzodiazepines (P = .007), and use of restraints (P < .001), were associated with longer stay in the intensive care unit. Nothing by mouth (P = .002) and restraint use (P = .003) were significantly associated with longer hospital stays. Bladder catheters were associated with hospital-acquired pressure injuries (odds ratio, 8.9; 95% CI, 1.2-67.9) and discharge to rehabilitation (odds ratio, 8.9; 95% CI, 1.2-67.9). Nothing by mouth (odds ratio, 3.2; 95% CI, 1.2-8.0) and restraints (odds ratio, 2.8; 95% CI, 1.4-5.8) were also associated with an increase in 30-day readmission. Although 95% of the patients were assessed at least once by using the Confusion Assessment Method for the Intensive Care Unit (overall 2334 assessments documented), only 3.4% had an assessment that indicated delirium; 54.6% of these assessments were inaccurate. Conclusion Although initiatives have increased awareness of the challenges, implementation of geriatric-focused practices in intensive care is inconsistent.
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Faculty; Northwell Researcher
School of Medicine; Northwell Health
General Internal Medicine; Hospital Medicine
Occupational Medicine, Epidemiology and Prevention