Quality of life and functional level in elderly patients surviving surgical intensive care

BACKGROUND: The elderly consume up to one third of health care resources an d have become a target for cost reduction efforts. This study was performed to evaluate elderly survivors of surgical critical illness using perceived quality of life and activities of daily living as indicators of value of c are. STUDY DESIGN: Six hundred seventy-two patients age 70 years and older admit ted to a surgical intensive care unit between October 1, 1992 and March 31, 1995 were studied. Intensive care unit and hospital length of stay, admiss ion type and service, and severity of illness were integrated with preadmis sion and current activities of daily living in survivors. Perceived quality of life was assessed where obtainable from patient or direct proxy. RESULTS: Activities of daily living were obtained on 342 (50.9%) and percei ved quality of life evaluations on 240 (35.7%) of the initial study Populat ion. Median duration from admission to evaluation was 21 months. Activities of daily living scores decreased significantly over-all from 4.75 +/- 0.72 (mean; +/- standard deviation) to 4.22 +/- 1.41, the proportion of complet ely independent patients fell from 84.9% to 72.0%, and the number of comple tely dependent patients rose from 0% to 3.8%. Perceived quality of life sco res were not significantly different than scores in healthy patients living in the community. Using regression models, age, service, APACHE II score, and emergent operation or admission did not demonstrate relationships to ch anges in activities of daily living scores. CONCLUSIONS: Although overall functional levels fell, rates of full depende ncy rose only slightly and perceived quality of life was high in a group of elderly patients surviving surgical intensive care. High hospital and post discharge mortality should not motivate restriction of care for elderly pat ients requiring surgical intensive care given their high postillness subjec tive quality of life measures. (J Am Coll Surg 2001; 193:245-249. (C) 2001 by the American College of Surgeons).