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PubMed2001

Health status of people with multiple sclerosis: a community mail survey.

We assessed the self-perceived health status of people with multiple sclerosis (MS) living in the Province of Milan, and the consequences of the disease on family, social and occupational status, using a cross-sectional mail survey. We identified 1350 adults with MS living in the Province of Milan. To a random sample of 400 of these, we sent out the multiple sclerosis quality-of-life-54 questionnaire (MSQOL-54), the proxy version of the short form-36 (SF-36), and a sociodemographic and clinical questionnaire. We received 261 replies (65%). Demographic and clinical data of responders and non-responders were similar except for frequency of hospitalisation over the last year, which was higher in responders. Compared to Italian norms, the MS patients had lower scores in all SF-36 domains; the differences were greatest for physical function, physical role limitations, vitality, and general health perceptions. Unemployment was 103 (41%) overall, 45% in women, and 54% in the less educated. A proxy informant was available for 245 (96%) responders. Concordance between patient and proxy reports on the SF-36 was moderate to excellent. MS had a pervasive impact on patients' lives, with substantial negative consequences for family and working life, that generally make themselves felt in the most active and productive period of people's live.

Adolescent↗

PubMed2005

Cost-effectiveness of memantine for moderate to severe Alzheimer's disease in Sweden.

BACKGROUND: Alzheimer's disease entails enormous costs for society and impairs quality of life for patients and caregivers. OBJECTIVE: This study estimated the cost-effectiveness of memantine in the treatment of patients with moderately severe to severe cognitive impairment from Alzheimer's disease in Sweden. METHODS: The study was based on published data from several sources, including a randomized controlled trial of memantine versus placebo and a longitudinal observational study of Alzheimer's disease patients in Sweden. Costs were estimated from the public payer's perspective, including direct costs but excluding costs of informal care, and resource utilization data were taken from the observational study. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from treatment with the use of previously published utility weights. A Markov simulation model was constructed, incorporating the effect of treatment on cognitive function, physical dependence related to activities of daily living, and institutionalization. Costs and effects for treated and untreated patients were estimated for 5 years (10 cycles). In the base-case analysis, treatment costs were added for 2 years, but the effect on transition probabilities was applied only for the first year of treatment. RESULTS: Compared with no treatment, memantine treatment was predicted to be associated with lower costs of care, longer time to dependence and institutionalization, and gains in QALYs. Treatment was estimated to decrease formal care costs by 123,600 Swedish kronor (SEK) and, after taking into account the cost of memantine, to lead to net cost savings of 100,528 SEK per patient. Treated patients gained 0.148 QALY over the 5-year simulation. CONCLUSIONS: From a public payer's perspective, the observed effect of memantine on cognitive and physical function is predicted to translate into economic benefits that offset the added treatment cost. Treatment is also predicted to delay institutionalization, improve independence, and increase QALYs.

Activities of Daily Living↗

PubMed2005

Anemia and the elderly: clinical considerations.

Anemia is a common problem in the management of elderly patients. Anemia in the elderly is linked to an increase in morbidity and mortality, and serves as an independent variable associated with poor outcomes. In the elderly population, anemia is a risk factor for cardiovascular health and early death, contributes to fatigue, and negatively impacts on cognitive function, physical function, and the quality of life and serves as a marker of increased vulnerability. A greater understanding of pathophysiology of anemia in the setting of chronic disease has provided insights into the rationale for the potential clinical application of erythropoietic agents in the treatment of anemia. The impact of erythropoietic therapy, as it relates to specific afflictions affecting the older age patient, including diminished exercise tolerance, frailty, loss of functional capacity, immobility, depression, increased care needs and cardiovascular fitness, remains to be determined and is worthy of further investigation.

Age Factors↗

PubMed2005

Health related quality of life after percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with acute coronary syndromes without ST-segment elevation. 12-month follow up.

OBJECTIVE: The efficacy of percutaneous and surgical revascularization in acute coronary syndromes without ST-segment elevation is similar. Therefore, other factors, like health-related quality of life, should play an important role in choosing the revascularization method. METHODS: We compared 12-month health-related quality of life for high-risk patients with acute coronary syndromes without ST-segment elevation assigned to percutaneous coronary intervention (group A) versus coronary artery bypass graft surgery (group B). Patients had an episode of rest angina within 24h prior to admission and had to fulfil at least one of the criteria: (1) ST-segment depression (>or=0.05mV), (2) transient (<20min) ST-segment elevation or T-wave inversion (>or=0.1mV), (3) positive serum cardiac markers. Four hundred and ninety-six (91.34%) of 543 patients alive 12-months after index hospitalization completed a Short Form-36 (SF-36) health status survey. Group A comprised 392 patients and group B comprised 104 patients. We compared mental component summary (MCS) and physical component summary (PCS) scores from the SF-36 survey between analyzed groups. RESULTS: There were no significant differences in MCS scores (47.21+/-12.30 vs. 46.60+/-11.3 in group A and group B, respectively, NS). PCS scores were lower in group A (38.30+/-11.10 vs. 42.64+/-9.76; p=0.003). Patients of group A had a higher rate of unstable angina (22.45 vs. 5.77%, p=0.0002) and repeated revascularization (12.76 vs. 1.92%, p=0.001) at 1 year. Patients of group A also had higher systolic and diastolic blood pressure during follow-up (138.17+/-20.41 vs. 133.47+/-19.21, p=0.04 and 82.48+/-11.32 vs. 77.25+/-16.17, p=0.0003, respectively). Systolic blood pressure was inversely associated with PCS scores in group A (Spearman's R= -0.18 p=0.0007). CONCLUSIONS: This study has shown that there is a significant difference in health-related quality of life 12-months after percutaneous coronary intervention and coronary artery bypass graft surgery. This difference arises from better physical function (physical component summary) for coronary artery bypass graft surgery patients compared with percutaneous coronary intervention patients. Despite impairment of the physical health status (physical component summary), the mental health status (mental component summary) remained similar in both groups.

Acute Disease↗

PubMed2005

Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: a comparative study.

BACKGROUND: Little is known about the factors that influence the health outcome of elderly patients suffering from heart failure or the health of their spouses. The aim of this comparative study was to determine if older patients suffering from heart failure and their spouses experience similar levels of health-related quality of life (HRQOL) and depression. The aim was also to identify those factors that contribute to HRQOL and depression in patient-spouse pairs. METHODS: Data were collected from 47 couples, using the Short Form 36 (SF-36) and Zung Self-rating Depression Scale (SDS) questionnaires. RESULTS: Patients suffering from heart failure and their spouses differed significantly in their experience of the physical, but not the mental, health-related quality of life, with patients experiencing significantly worse physical functioning. Physical symptoms of heart failure seemed to dominate the experience of the patient and was positively related to mental health and inversely related to the New York Heart Association classification (NYHA class) and patients' depression. Depressive symptoms as reflected in SDS showed no significant difference between patients and spouses. Patients' depression was positively related to high NYHA class, while spouse depression was positively related with higher age of the patient. CONCLUSION: Physical symptoms seem to dominate the experience of heart failure.

Aged↗

PubMed2000

A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring.

OBJECTIVE: The goal of this study was to compare the effectiveness of home-based, transtelephonically monitored cardiac rehabilitation with standard, on-site, supervised cardiac rehabilitation. BACKGROUND: Participation in cardiac rehabilitation has been demonstrated to increase exercise capacity, decrease cardiovascular symptoms, improve psychosocial status, and decrease total and cardiovascular mortality rates in patients with coronary heart disease. Because of multiple factors, national overall participation is only at 15% of eligible patients. METHODS: Effects of a 3-month home-based, transtelephonically monitored rehabilitation program (n = 83 patients) with simultaneous voice and electrocardiographic transmission to a centrally located nurse coordinator were compared with effects of a standard on-site rehabilitation program (n = 50 patients). The study design was a multicenter, controlled trial. Primary outcome variables were peak aerobic capacity and quality of life, as measured by the Health Status Questionnaire. RESULTS: Patients in the home-based monitoring program increased peak aerobic capacity to a similar degree as patients who exercised on site (18% vs 23%). Quality of life domains of physical functioning, social functioning, physical role limitations, emotional role limitations, bodily pain, and energy/fatigue improved similarly in both groups. There were no circulatory arrests or other major exercise-related medical events in either group. A total of 3100 hours of home exercise were transtelephonically monitored. CONCLUSIONS: Patients with coronary heart disease can effectively participate in home-based, monitored cardiac rehabilitation, with exercise and quality of life improvements comparable to those demonstrated at on-site programs.

Age Factors↗

PubMed2002

Andropause and quality of life: findings from patient focus groups and clinical experts.

OBJECTIVES: To develop a condition-specific quality of life (QoL) questionnaire to assess the symptoms of the decline in testosterone that occurs as men age, otherwise known as the andropause. METHODS: Two focus groups of patients with low testosterone levels and an expert panel of physicians in the treatment of male testosterone deficiency. RESULTS: The patient focus groups confirmed that men are unlikely to realise they have low testosterone levels until this is diagnosed and that they are unlikely to share their experiences with peers. Both patients and physicians considered decreased energy levels and impaired sexual performance had the greatest adverse impact on well-being. Patients generally felt that testosterone replacement therapy led to improved energy levels and, to a lesser extent, improved libido and erectile function. Evaluation of the responses resulted in the identification of seven key domains (energy, emotional, social, social emotional, mental functioning, physical functioning and sexual functioning) that should be considered when assessing the impact of andropause on QoL. CONCLUSIONS: Understanding the impact of low testosterone levels on QoL is critical to diagnosis and effective treatment. The use of an andropause-specific QoL questionnaire will facilitate quantification of patient experiences and may thus improve subsequent therapy.

Aged↗

PubMed2002

Psychological evaluation of patients diagnosed with fibromyalgia syndrome: a comprehensive approach.

Symptoms of FMS are extremely distressing, and currently there is no cure or any treatment capable of substantially reducing all symptoms for all patients. Rehabilitation goals include improving emotional functioning, physical functioning, and quality of life. In light of these goals, psychological screening is an essential component of any comprehensive FMS evaluation. In many cases, the high levels of emotional distress, disability, and reduced quality of life noted in these patients warrants a more thorough psychological evaluation [11]. A comprehensive psychological evaluation is complex, involves exploration of a broad range of areas, and should be administered by an experienced health psychologist. The primary objective of this evaluation is to delineate emotional, cognitive, and behavioral factors involved in persistent pain, suffering, and disability, with an emphasis on the prescription of appropriate interventions for altering maladaptive patterns. The results of the psychological evaluation involve a synthesis of information and should assist in developing a list of behavioral problems that contribute to the maintenance and exacerbation of [table: see text] suffering and disability. Information obtained should facilitate treatment planning, specifically the matching of treatment components to the needs of individual patients.

Fibromyalgia↗

PubMed2002

Diagnosing non-palpable breast disease: short-term impact on quality of life of large-core needle biopsy versus open breast biopsy.

BACKGROUND: One of the alleged advantages of stereotactic large-core needle biopsy of non-palpable breast lesions is that it entails less inconvenience for the patient. In this prospective study, the quality of life of patients undergoing large-core needle biopsy was compared with that of patients undergoing open breast biopsy prior to learning the definitive diagnosis. METHODS: Thirty patients with non-palpable breast lesions underwent stereotactic large-core needle biopsy as initial diagnostic procedure (needle biopsy group). Quality of life as perceived by these patients was compared with that of 27 patients who underwent open breast biopsy as initial diagnostic procedure (control group). Both groups completed quality of life questionnaires (EuroQol and SF-36) 1 day before and 4 days after the diagnostic intervention. RESULTS: One day before the diagnostic procedure, the overall estimate for quality of life (measured with the EuroQol) was slightly higher in the needle biopsy group than in the control group (73 versus 69 resp.). Four days after the diagnostic procedure, the quality of life score remained approximately unchanged in the needle biopsy group, but was reduced in the control group (71 versus 61 resp.). Results of the SF-36 questionnaire demonstrated that patients in the needle biopsy group had higher quality of life scores on physical functioning, physical performance, pain and social performance after the diagnostic intervention. CONCLUSION: Stereotactic large-core needle biopsy seems to affect quality of life to a lesser extent than open breast biopsy. This difference is mainly attributable to a reduction of physical discomfort and pain.

Biopsy, Needle↗

PubMed2007

Meta-analysis of psychological interventions for chronic low back pain.

The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.

Cognitive Behavioral Therapy↗

PubMed2002

Propranolol for small abdominal aortic aneurysms: results of a randomized trial.

PURPOSE: Animal and human studies have suggested that beta-blockade may decrease the growth rate of aneurysms. We investigated whether propranolol decreases the growth rate of small abdominal aortic aneurysms (AAAs). METHODS: We randomly assigned patients with an asymptomatic AAA between 3.0 and 5.0 cm to receive either a placebo (n = 272) or propranolol (n = 276) in a double-blind fashion. Patients were observed for a mean of 2.5 years. The primary end point was the mean annual growth rate as determined by means of ultrasound scanning performed every 6 months. Secondary outcomes were death, surgery, withdrawal from study medication, and quality of life measured by means of the Short-form Health Survey (SF-36). The main analyses were performed by means of intention to treat. RESULTS: The two groups were similar at baseline: 84% were men with a mean age of 69 years and a mean AAA size of 3.8 cm. Fewer patients in the placebo group stopped their study medication (26.8% vs 42.4%; P =.0002). The annual growth rate was similar in the two groups (placebo, 0.26 cm/y vs propranolol 0.22 cm/y; P =.11). There was a trend toward more elective surgery in the placebo group (26.5% vs 20.3%; P =.11), but there was no difference in death rate (placebo, 9% vs propranolol, 12%; P =.36). Patients in the propranolol group had significantly poorer quality of life scores in the physical functioning, physical role, and vitality dimensions of the SF-36. CONCLUSION: Patients with AAAs do not tolerate propranolol well, and the drug did not significantly affect the growth rate of small AAAs.

Adrenergic beta-Antagonists↗

PubMed1992

Racial and social correlates of age-related changes in functioning.

Six waves of observations spanning a decade on a panel of 566 Black and 5,196 non-Black survivors were utilized to examine social and racial differences in age-related changes in functioning. An index consisting of three dimensions was used to assess functioning: physical functioning, self-care capacity, and self-rated well-being. Growth curve analysis was used to assess variations in trajectories of functional impairment across Black/non-Black, poor/nonpoor, male/female, and high-school/non-high-school graduate subpanels. Trajectories vary across social groups in the expected manner. However, we note that the trajectories are not linear and that substantial variability exists within both the Black and non-Black subpanels. Moreover, we note that Blacks report poorer functional status than non-Blacks even with income and education controlled. However, age changes do not differ across Black and non-Black subpanels, as predicted by the multiple-jeopardy hypothesis.

Activities of Daily Living↗

PubMed2004

Epidemiology of hip and knee pain and its impact on overall health status in older adults.

OBJECTIVES: To obtain prevalence rates of hip and knee pain in elderly people and compare combinations of symptoms with overall health status. METHODS: We performed a cross-sectional postal survey of a random sample of 5500 Oxfordshire residents aged 65 yr and older. Prevalence estimates were based on the screening question: 'During the past 12 months, have you had pain in or around either of your hip/knee joints on most days for one month or longer?' Overall health status was assessed with the SF-36 questionnaire. RESULTS: The response rate was 66.3% (3341/5039 eligible people), and was highest (approximately reverse similar 72%) for the 65-74 yr age-group. The percentage reporting hip pain was 19.2% [95% confidence interval (CI) 17.9-20.6], and 32.6% (95% CI 31.0-34.3) reported knee pain. The percentage reporting hip and knee pain was 11.3%, and 40.7% reported hip or knee pain. Less than half (48%) of the symptomatic respondents had unilateral problems affecting one hip or knee joint only. SF-36 scores worsened as the number of symptomatic hip and knee joints increased (P<0.001 for physical function, physical role limitation and bodily pain). CONCLUSIONS: Patterns of hip and knee symptoms are complex in older people. Amongst the symptomatic, most have more than one hip/knee affected. This has implications for treatment and health status measurement. In the absence of hip and knee symptoms, general health status scores of elderly people are similar to those of people aged under 65 yr.

Aged↗

PubMed1998

The impact of postoperative pain on the development of postoperative delirium.

UNLABELLED: We performed a prospective observational study to examine the role of postoperative pain and its treatment on the development of postoperative delirium. Pain was measured in direct patient interviews using a visual analog scale (VAS) and was assessed for pain at rest, pain with movement, and maximal pain over the previous 24 h. Postoperative delirium was diagnosed during these interviews by using the confusion assessment method (CAM) and/or by using data from the medical record and the hospital's nursing intensity index. The method of postoperative analgesia, type of opioid, and cumulative opioid dose were also recorded. After controlling for known preoperative risk factors for delirium (age, alcohol abuse, cognitive function, physical function, serum chemistries, and type of surgery), higher pain scores at rest was associated with an increased risk of delirium over the first 3 postoperative days (adjusted risk ratio 1.20, P = 0.04). Pain with movement and maximal pain were not associated with delirium. Method of postoperative analgesia, type of opioid, and cumulative opioid dose were not associated with an increased risk of delirium. We conclude that more effective control of postoperative pain reduces the incidence of postoperative delirium. IMPLICATIONS: We performed daily interviews in a large population of patients undergoing noncardiac surgery to measure their level of pain and development of delirium. We found an association between higher pain levels at rest and the development of delirium. Our results suggest that better control of postoperative pain may reduce this serious complication.

Activities of Daily Living↗

PubMed2001

Exercise in chronic pulmonary disease: resistance exercise prescription.

Resistance exercise training has received relatively little attention as a means to reduce the muscle dysfunction and ensuing exercise intolerance seen in chronic pulmonary diseases. To date, only a few studies have examined the characteristics of skeletal muscle function or its responsiveness to strength training in patients with chronic respiratory diseases. It is clear from these studies, however, that peripheral muscle, particularly muscles of ambulation, are weak in patients with lung disease, exhibiting effort-dependent strength scores that are 70--80% of these measures in age-matched healthy subjects. The degree to which this dysfunction is accounted for by deconditioning, disease-related myopathy, or other causes is unclear. It is evident, however, that patients with chronic respiratory diseases can acquire and maintain substantial improvements in skeletal muscle function, physical function, and quality of life through participation in a well-structured program of resistance exercise training. Despite the positive, albeit limited, evidence that skeletal muscle dysfunction may be improved with resistance training, no clear guidelines are available for this purpose. This review discusses the skeletal muscle dysfunction that accompanies chronic respiratory disease and presents strategies for resistance exercise training that may be considered as part of pulmonary rehabilitation. These strategies are derived from the successful outcomes noted in studies using resistance training in patients with COPD as well as on extrapolations from extant guidelines used to develop strength, power, and endurance in healthy individuals.

Exercise Therapy↗

PubMedDate not supplied

Psychometric testing of the revised 15-item Bakas Caregiving Outcomes Scale.

BACKGROUND: Family caregivers of stroke survivors experience a variety of negative social, emotional, and health-related outcomes as a result of providing care. OBJECTIVES: : To psychometrically test the revised 15-item Bakas Caregiving Outcomes Scale (BCOS) measuring life changes specifically resulting from providing care. The original 10-item BCOS was improved by adding five items addressing financial well-being, level of energy, role functioning, physical functioning, and general health. METHODS: Psychometric testing of the revised 15-item BCOS using a sample of 147 family caregivers of stroke survivors approximately 4 months after stroke was conducted to determine the quality of the items, internal consistency reliability, test-retest reliability, construct validity, and criterion-related validity. Most caregivers were women (78.9%), White (68.0%) or African American (29.9%), and either spouses (60.1%) or adult children (31.3%). RESULTS: Satisfactory evidence of internal consistency (alpha = .90) and 2-week test-retest reliability (intraclass coefficient [ICC] = .66; 95% confidence interval [CI] = 0.42-0.81) was provided, with item-to-total correlations ranging from .41 to .74. Unidimensionality was supported by confirmatory factor analysis with indices, indicating a good fit. Using hierarchical multiple regression, 36% of the BCOS variance was explained by constructs in the conceptual model [F(11,132) = 6.72, p < .001]. Criterion-related validity was supported by correlations with the 36-item Short Form (SF-36) General Health Subscale (r = .32, p < .001) and a criterion variable measuring how caregivers' lives had changed overall (r = .67, p < .001). DISCUSSION: The revised 15-item BCOS has evidence of satisfactory reliability and validity in family caregivers of stroke survivors. The BCOS is a valuable measure in research and can be used to identify priority areas for nursing interventions designed to improve caregivers' outcomes.

Adaptation, Psychological↗

PubMed2006

The impact of comorbidities on the change in short-form 36 and oswestry scores following lumbar spine surgery.

STUDY DESIGN: This is an observational study of 3482 patients undergoing lumbar spine surgery from the National Spine Network. OBJECTIVES: To explore the influence of medical and psychosocial comorbidities on the change in Short-form 36 (SF-36) general health survey and condition-specific Oswestry Disability Index (ODI) scores in patients undergoing lumbar spine surgery. SUMMARY OF BACKGROUND DATA: It remains unclear as to which type of health instrument is more appropriate for monitoring improvement in patients who undergo lumbar spine surgery. Most clinicians would suspect that comorbidities (medical and psychosocial) play a significant role in the outcome of spine patients. Yet, it has been difficult to quantify specifically the impact of comorbidities on the responsiveness of traditional health status instruments for spine patients. METHODS: Analysis of variance was performed to assess the difference in the change in survey scores across comorbidity groups for the population of National Spine Network patients who had undergone lumbar spine surgical intervention and completed 3-month and 1-year follow-up surveys. Multiple linear regressions were used to identify the most influential individual comorbidities on the change scores. RESULTS: Comorbidities had a significant impact on the change in scores at 3 months and 1 year. The average change in bodily pain, physical function, physical component summary scores of the SF-36, as well as ODI scores decreased in response to surgery as the number of comorbidities increased. Psychosocial comorbidities such as an active compensation case, self-rated poor health, and smoking exerted large effects on the change in survey scores after surgery (P < 0.003). Medical disorders such as headaches, depression, and nervous system disorders were also highly influential (P < 0.05). CONCLUSIONS: The negative impact of medical and psychosocial comorbidities on the change in SF-36 general health survey and condition-specific ODI scores, despite spine surgery, highlights the need for researchers and clinicians to consider these comorbidities when using these, and perhaps all, health survey instruments and interpreting these scores after surgery. Contrary to current assumptions regarding condition-specific health surveys, medical and psychosocial comorbidities similarly affect the generic SF-36 and condition-specific ODI. Further studiesare needed to determine if spine surgery outcomes can be improved by specifically addressing potentially modifiable comorbidities, which negatively impact survey scores, or whether comorbidity burden should play a role in the selection process for surgical intervention. Failure to incorporate consideration of medical and psychosocial comorbidities into preoperative discussions can be a failure to allow our patients (and ourselves) to have realistic expectations and, consequently, the best possible outcome from their treatment choice.

Aged↗

PubMed2006

Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients.

OBJECTIVES: To assess mortality, quality of life (QOL), and quality-adjusted life-years (QALYs) for critically ill elderly patients. DESIGN: Cross-sectional survey. SETTING: A ten-bed medical-surgical intensive care unit (ICU) in a tertiary care university hospital. PATIENTS: The study group included 882 elderly patients (> or =65 yrs of age) and 1,827 controls (<65 yrs of age) treated during the period of 1995 to 2000. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Mortality was assessed during the ICU and hospital stays, and 12, 24, and 36 months after ICU discharge. The cumulative 3-yr mortality rate among the elderly (57%) was higher (p < .05) than that among the controls (40%). The majority (66%) of the elderly nonsurvivors died within 1 month after intensive care discharge. All elderly patients with day-1 Sequential Organ Failure (SOFA) scores >15 died during the ICU stay. QOL was assessed with EQ-5D and RAND-36 measures from 10 months to 7 yrs after discharge. The majority (88%) of the elderly survivors assessed their present health state as good or satisfactory; 66% found it to be similar or better than 12 months earlier, and 48% similar or better than their preadmission state. QOL measures by RAND-36 revealed that aging decreased their competencies most in physical functioning, physical role limitations, and vitality, but the elderly had better values in mental health than the controls. However, QALYs of the elderly respondents were 21% to 35% lower than the mean QALY minus 2 sd units of the age- and gender-adjusted general population. CONCLUSIONS: High age alone is not a valid reason to refuse intensive care, but the benefits perceived by intensive care seem to decrease with aging, if reflected as QALYs. However, 97% of the elderly survivors lived at home and 88% of them considered their QOL satisfactory or good after hospital discharge. Therefore, more reliable information on the outcome for the elderly is clearly needed.

APACHE↗