Five-year mortality and functional trajectories in older survivors of intensive care compared to the general population

Abstract

Purpose: While admission to intensive care becomes more frequent amongst older adults, there is a scarcity of data on functional trajectories and long-term mortality in survivors compared to the general population. This study addresses this gap to inform advance care planning and identify cohorts for improving functional outcomes after intensive care. Methods: This observational study investigated 5-year survival and functional trajectories in individuals, aged 60–99 years, who were members of a statutory health insurance organisation in Germany. These organisations cover the cost of universal healthcare, which is standardised by national regulations. Admission to intensive care was identified by claims data. Grading of functional deficits was performed through a nationwide programme for evaluating eligibility for long-term care support. Trajectories of competing outcomes were obtained by multi-state modelling. Results: We examined longitudinal data of 3,261,169 older individuals, 40,441 of those survived intensive care by at least 6 months. Excess mortality within 5 years after intensive care peaked in previously fit survivors, aged 60–79 years, who also had a higher risk for functional decline in comparison to their peers in the general population. Advanced age was an attenuating factor, with differences disappearing amongst nonagenarians. Women were at a higher risk than men for transition from having no functional deficit to mild–moderate deficits. Conclusion: Amongst adults aged 60–89 years, the impact of critical illnesses is still detectable 5 years after surviving intensive care. Notwithstanding the non-causal nature of associations, interventions to improve long-term functional outcomes could be most effective in individuals aged 60–79 years.