Abstract
OBJECTIVES
The influence of age upon intensive care unit (ICU) decision-making is complex and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making we explored patient-assessed quality of life (QoL) in ICU survivors before the COVID-19 pandemic.
DESIGN
A systematic review and meta-analysis of cohort studies published between January 2000 to April 2020, of elderly patients admitted to ICUs.
PRIMARY AND SECONDARY OUTCOME MEASURES
We extracted data on self-reported QoL (EQ-5D composite score), demographic and clinical variables. Using a random-effects meta-analysis, we then compared QoL scores at follow-up to scores either before admission, age-matched population controls or younger ICU survivors. We conducted sensitivity analyses to study heterogeneity and bias, and a qualitative synthesis of subscores.
RESULTS
We identified 2536 studies and included 22 for qualitative synthesis and 18 for meta-analysis (N= 2326 elderly survivors). Elderly survivors’ QoL was significantly worse than younger ICU survivors, with a small-to-medium effect size (d= .35 [-.53, -.16]). Elderly survivors’ QoL was also significantly greater at follow-up, compared to slightly before ICU, with a small effect size (d= .26 [-.44, -.08]). Finally, their QoL was also marginally significantly worse than age-matched community controls, also with a small effect size (d= .21 [-.43, .00]). Mortality rates and length of follow up partly explained heterogeneity. Reductions in QoL seemed primarily due to physical health, rather than mental health items.
CONCLUSIONS
The results suggest that the proportionality of age as a determinant of ICU resource allocation should be kept under close review and that subjective QoL outcomes should inform person-centred decision making in elderly ICU patients.
The influence of age upon intensive care unit (ICU) decision-making is complex and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making we explored patient-assessed quality of life (QoL) in ICU survivors before the COVID-19 pandemic.
DESIGN
A systematic review and meta-analysis of cohort studies published between January 2000 to April 2020, of elderly patients admitted to ICUs.
PRIMARY AND SECONDARY OUTCOME MEASURES
We extracted data on self-reported QoL (EQ-5D composite score), demographic and clinical variables. Using a random-effects meta-analysis, we then compared QoL scores at follow-up to scores either before admission, age-matched population controls or younger ICU survivors. We conducted sensitivity analyses to study heterogeneity and bias, and a qualitative synthesis of subscores.
RESULTS
We identified 2536 studies and included 22 for qualitative synthesis and 18 for meta-analysis (N= 2326 elderly survivors). Elderly survivors’ QoL was significantly worse than younger ICU survivors, with a small-to-medium effect size (d= .35 [-.53, -.16]). Elderly survivors’ QoL was also significantly greater at follow-up, compared to slightly before ICU, with a small effect size (d= .26 [-.44, -.08]). Finally, their QoL was also marginally significantly worse than age-matched community controls, also with a small effect size (d= .21 [-.43, .00]). Mortality rates and length of follow up partly explained heterogeneity. Reductions in QoL seemed primarily due to physical health, rather than mental health items.
CONCLUSIONS
The results suggest that the proportionality of age as a determinant of ICU resource allocation should be kept under close review and that subjective QoL outcomes should inform person-centred decision making in elderly ICU patients.
| Original language | English |
|---|---|
| Journal | BMJ Open |
| DOIs | |
| Publication status | Published - 2021 |