Critical Care Challenges and Mortality Predictors in Older Adults: A Comprehensive Cohort Analysis

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PURPOSE: As the population ages, critically ill older adults increasingly face complications and require more healthcare resources during hospitalization. Since post-ICU (intensive care unit) mortality is an important consideration, particularly in elderly populations, this study aims to assess whether advanced age impacts ICU and post-ICU mortality by comparing outcomes between patients aged 81 years and above with those below 81 years. METHODS: This retrospective study analyzed data from 3,821 ICU patients treated at the Unidade Local de Saúde de Lisboa Ocidental between 2015 and 2023. Key variables included age, gender, ICU length of stay, and severity scores (APACHE [Acute Physiology and Chronic Health Evaluation] II, SAPS [Simplified Acute Physiology Score] II/III, SOFA [Sequential Organ Failure Assessment]). Patients with incomplete records, readmissions, ICU stays shorter than 24 hours, or those under 18 years of age were excluded. RESULTS: Mortality was significantly higher in patients aged 81 years and above compared to those under 81. Among patients aged 81 and above, ICU mortality was 22% (152 deaths), compared to 13% (342 deaths) in the younger group. Similarly, post-ICU mortality was 20% (138 deaths) for the older group, substantially higher than the 5% (131 deaths) observed in patients below 81 years. The SAPS II and SOFA scores were critical predictors of mortality. Even after adjusting for these scores, older patients still showed higher mortality rates. CONCLUSION: This study demonstrated that advanced age is a major factor influencing mortality in critically ill patients, particularly among those aged 81 years and above. These patients faced higher mortality rates both during ICU stays and after discharge, emphasizing the importance of age-specific strategies in managing critically ill elderly populations.

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