Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study

Annals of Intensive Care volume 15, Article number: 13 (2025)

Published: 20 January 2025

Objective

To understand the impact of both frailty and chronologic age on outcomes of weaning from invasive mechanical ventilation (MV).

Methods

The study population consisted of patients enrolled in the ‘WorldwidE. AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE) study. We defined 4 non-overlapping groups, namely: ‘frail’ (clinical frailty scale [CFS] score > 4; age < 80 years); ‘elderly’ (CFS ≤ 4; age ≥ 80y), ‘frail \elderly’ (CFS > 4; age ≥ 80 years), and a ‘not frail or elderly’ population. The primary outcome was the impact of frailty and older age on delayed weaning and failed weaning from invasive MV. Secondary outcomes included the impact of frailty and age on ICU and hospital survival.

Results

In the study population, 760 (17%) were frail, while 360 (8%) were elderly, 197 (4%) were frail and elderly, while 3,176 (70%) were not frail or elderly. The frail and elderly cohorts were more likely to be female, had hypoxemic/hypercapnic respiratory failure or sepsis, and had more comorbidities. The proportion of delayed weaning and of failed weaning from invasive MV was significantly higher in the frail (28 and 23%), the elderly (25 and 19%), and the frail and elderly groups (22% and 25%), compared to the not frail or elderly population (12% and 13%, P < 0.01). ICU and hospital mortality was higher in the frail (21 and 33%), the elderly (19 and 31%), and the frail and elderly groups (26 and 46%), compared to the not frail or elderly population (12% and 18%, P < 0.001). In multivariate analyses, there was an independent association between frailty and delayed weaning initiation and weaning failure. Old age was independently associated with risk of weaning failure.

Conclusions

Frailty status had a more consistent impact than older age on weaning outcomes. However, overall outcomes in these cohorts are encouraging once separation attempts have been initiated.

 

Relationship between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors

Relationship between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors

Critical Care Medicine: April 2016 - Volume 44 - Issue 4 - p 655–662

Moitra, V et al

Objectives: To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States. Design: Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1- and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation. Interventions: None. Patients: The cohort included 34,696 Medicare beneficiaries older than 65 years who received intensive care and survived to hospital discharge in 2005. Measurements and Main Results: Among 34,696 patients who survived to hospital discharge, the mean ICU length of stay was 3.4 days (± 4.5 d). Patients (88.9%) were in the ICU for 1–6 days, representing 58.6% of ICU bed-days. Patients (1.3%) were in the ICU for 21 or more days, but these patients used 11.6% of bed-days. The percentage of mechanically ventilated patients increased with increasing length of stay (6.3% for 1–6 d in the ICU and 71.3% for ≥ 21 d). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for 1 day, up to 57.8% for patients in the ICU for 21 or more days. For each day beyond 7 days in the ICU, there was an increased odds of death by 1 year of 1.04 (95% CI, 1.03–1.05) irrespective of the need for mechanical ventilation. Conclusions: Increasing ICU length of stay is associated with higher 1-year mortality for both mechanically ventilated and non–mechanically ventilated patients. No specific cut off was associated with a clear plateau or sharp increase in long-term risk.

Equity of Access to Critical Care Among Elderly Patients in Scotland: A National Cohort Study

Equity of Access to Critical Care Among Elderly Patients in Scotland: A National Cohort Study

Critical Care Medicine: January 2016 - Volume 44 - Issue 1 - p 3–13
Docherty, A; Anderson, N et al


Objective: To compare elderly (≥ 80 yr), older (65–79 yr), and younger (< 65 yr) ICU admissions in Scotland in relation to trends in admission rates, regional variation in admissions, ICU treatment intensity, and ICU and 1-year mortality. Design: National 5-year cohort study of ICU first admissions (January 1, 2005, to December 31, 2009). Setting: All admissions to ICUs and combined units (level 2/3 care) in Scotland captured by the Scottish Intensive Care Society Audit Group database, linked with hospital discharge data and death records. Patients: A total of 40,142 patients: 3,865 were 80 years old or older (9.6%), 13,904 (34.6%) were 65–79 years old; and 22,373 were younger than 65 years (55.7%). Interventions: None. Measurements and Main Results: Between 2005 and 2009, elderly admission rates decreased from 36.6/10,000 (95% CI, 34.0–39.2) in 2005 to 28.7/10,000 (95% CI, 26.5–30.9) in 2009 (p < 0.001; relative decrease, 22.0%); older admission rates also decreased, but less steeply (31.1 [95% CI, 29.9–32.2] to 26.1 [95% CI, 25.1–27.1] per 10,000 population; p < 0.001; relative decrease, 16.1%). Rates were static for younger patients. Restricted to mechanically ventilated elderly patients, rates ranged from 13.9 to 30.1/10,000 between healthboard administrative regions (p < 0.001). Emergency surgical diagnoses were more prevalent for elderly patients (elderly, 39.8%; older, 25.1%; younger, 20.3%; p < 0.001). Subgroup analyses limited to pneumonia admissions (elderly, n = 242; older, n = 1,226; younger, n = 1,836) indicated similar acute physiology scores, but fewer preexisting comorbidities among elderly patients (p = 0.007), who received a shorter duration of organ support and ICU stay. Mortality rates were higher in elderly patients at ICU discharge (elderly, 26.5%; older, 25.0%; younger, 17.0%; p < 0.001; confounder adjusted odds ratio elderly vs younger, 2.33 [95% CI, 2.11–2.58]; p < 0.001). Differences persisted at 1 year (elderly, 52.2%; older, 43.8%; younger, 27.6%; adjusted odds ratio elderly vs younger, 3.72 [95% CI, 3.42–4.06]; p < 0.001). Conclusions: In Scotland, elderly and older ICU admission rates are decreasing, with regional geographic variation. Although limited by an absence of a measure of frailty, patient characteristics and treatment intensity suggest selection of less comorbid elderly patients, indicating possible rationing based on chronologic age.

Skeletal muscle predicts ventilator-free days, ICU-free days and mortality in elderly ICU patients

Skeletal muscle predicts ventilator-free days, ICU-free days and mortality in elderly ICU patients. Critical care, Sept 2013, 17: R206

Mosiey, L.L., et al.

http://ccforum.com/content/pdf/cc12901.pdf

As the population ages, the number of injured elderly is increasing. We sought to determine if 
low skeletal muscle mass adversely affected outcome in elderly patients following trauma.

Mortality in healthy elderly patients after ICU admission.

Intensive Care Medicine

pp. 550-555
Mortality in healthy elderly patients after ICU admission.
Sacanella, E.; Pérez-Castejón, J. M.; Nicolás, J. M.; Masanés, F.; Navarro, M.; Castro, P.; López-Soto, A.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN245470810&field=zid

The very elderly in intensive care : admission characteristics and mortality

Author(s): Ryan , D . ; Conlon , N . ; Phelan , D . ; Marsh , B .
ISSUE: 2008 ; VOL 10 ; PART 2
Access: Critical Care and Resuscitation
Page: 106-110
Search the Web: [article] [author(s)]

The very elderly in intensive care: admission characteristics and mortality.

Crit Care Resusc. 2008 Jun;10(2):110. LinkOut

Ryan D, Conlon N, Phelan D, Marsh B.
Department of Anaesthesia and Intensive Care Medicine, Mater Misericordiae Hospital, Dublin, Ireland. dryan27@hotmail.com.

OBJECTIVE: It is often assumed that critical care outcomes in the elderly are uniformly poorer than those in younger populations. We examined the pattern of admissions to our intensive care unit in Dublin, Ireland, between 2002 and 2005 to determine the admission characteristics and mortality in those aged 80 years and older. METHODS: Data were collected retrospectively from a local audit database and patient charts.

RESULTS: The very elderly represented 5.1% of ICU admissions over the period with an ICU mortality of 15.4%. Age-adjusted APACHE II scores were similar to those in the younger group (median, 7 for both groups). The average length of ICU stay (+/-SD) was similar in the very elderly and younger groups (4.03+/-0.51 v 4.86+/-0.31 days; P=0.52), as were readmission rates (5.7% v 5.2%).

Dexmedetomidine as an adjunct to epidural analgesia after abdominal surgery in elderly intensive care patients: A prospective, double-blind, clinical

Current Therapeutic Research, Volume 69, Issue 1, February 2008,
Pages 16-28
Sule Akin, Anis Aribogan and Gulnaz Arslan
http://www.sciencedirect.com/science/science?_ob=GatewayURL&_method=citationSearch&_urlVersion=4&_origin=SDSRCHALERTASCII&_version=1&_uoikey=B6VS8-4S62MFF-3&md5=b172ccc0b28d116b8cd0223667b1583b

Multicomponent Geriatric Intervention for Elderly Inpatients With Delirium : Effects on Costs and Health - Related Quality of Life

Author(s): Pitkala , K . H . ; Laurila , J . V . ; Strandberg , T . E . ; Kautiainen , H . ; Sintonen , H . ; Tilvis , R . S . ISSUE: 2008 ; VOL 63 ; PART 1
Journal Title:Journals of Gerontology : Series A , Biological Sciences and Medical Sciences ( Formerly : Journal of Gerontology , the ) From Proquest NHS (05/1995 - 12/2007)

Abstract (Summary)
Delirium is a common syndrome with poor prognosis affecting elderly inpatients. Treatment is mainly based on common sense with wide variations in practice. We investigated whether intensified, multicomponent geriatric treatment could improve the prognosis of delirious patients. We performed a randomized, controlled trial of 174 patients with delirium in six general medicine units from an acute hospital in Helsinki, Finland. The intervention group received individually tailored geriatric treatment. The primary endpoint was the sum of those deceased individuals and the patients permanently institutionalized. Secondary endpoints included the number of days in hospitals and other institutions, delirium intensity, and cognition. The mean age of patients was 83 years, and 31% had previous dementia. The intervention group (N = 87) received significantly more acetylcholinesterase inhibitors (58.6% vs 9.2%), atypical antipsychotics (69.8% vs 30.2%), specialist consultations (49.4% vs 28.7%), hip protectors (88.5% vs 3.4%), physiotherapy (87.4% vs 47.1%), and fewer conventional neuroleptics (8.0% vs 23.0%) than did the control group (N = 87). During the 1-year follow-up, 60.9% of the intervention group and 64.4% of controls were either deceased or permanently institutionalized (p = .638). The intervention group spent a mean of 126 days in institutions, and the control group 140 days (p = .688). Delirium was, however, alleviated more rapidly during hospitalization, and cognition improved significantly at 6 months in the intervention group. Faster alleviation of delirium and improved cognition justify good, comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis.