Trends in admission, resource use and outcomes among elderly patients admitted to an intensive care unit in China.

Abstract

Population aging, coupled with improvements in healthcare, may influence ICU admission trends and care practices among critically ill elderly patients (≥80 years), longitudinal data evaluating this remain limited in China. Our aim was to analyze and compare trends in ICU admissions, clinical outcomes, and resource use among critically ill elderly patients (≥80 years), in comparison with older (65-79 years) and younger (16-64 years) cohorts. We retrospectively analyzed ICU patients aged ≥16 years admitted to a tertiary referral hospital in China from January 2014 to December 2021. A total of 31,535 patients were categorized into three age groups: ≥ 80 years (11.5%), 65-79 years (30.7%), and <65 years (57.8%). ICU admission rates for elderly patients declined significantly from 13.2% in 2014 to 9.0% in 2021 (p < 0.001, relative decrease 31.8%), particularly among nonsurgical admissions. Elderly patients had higher comorbidities, greater disease severity scores, but lower daily average TISS-28 scores compared to younger cohorts. They were more likely to receive inotropic/vasopressor support and nutritional interventions, had higher blood loss due to frequent laboratory testing, and required more red blood cell transfusions. However, they were less likely to undergo invasive ventilation. The proportion of elderly patients requiring invasive ventilation decreased significantly over the study period. Despite a higher hospital mortality rate (elderly 14.1%, older 6.1%, younger 3.1%; p < 0.001), elderly patients demonstrated a more significant reduction in risk-adjusted mortality over time compared to younger patients (elderly vs. younger, 12.5% vs. 6.3%, relative reduction per year, p < 0.001). ICU admission rates for elderly patients are declining, particularly in nonsurgical cases. Less invasive life support modalities have been increasingly utilized in their care. While mortality remains higher among elderly patients, they demonstrate a more significant improvement in survival over time compared to younger cohorts.