Frailty in Intensive Care: Demonstrating A Need For Geriatric ICU Service

Abstract Background Ireland has an aging population, with the population over 75 projected to increase by 50% between 2022 and 2023. Collaborations, such as Orthopeadics and Trauma Geriatrics, have improved outcomes for older patients. The rise in older patients admitted to Intensive Care Units (ICU) demonstrates a need for further specialist Geriatrician input. Methods A descriptive snapshot of patients over 74 admitted to a quandary hospital’s ICU in 2023. Data collected over 12 months for the National Office of Clinical Audits (NOCA) ICU audit was evaluated for clinical frailty, mortality, and organ supports as a marker of level of care received. Results In 2023, 166 patients aged 75+ (mean 79) were admitted to ICU. Surgical admissions (N= 104) were more common in patients in their 70s; medical admissions (N=62) in those in their 80s. Only 2 patients in their 90s were admitted. The average CFS was 4, 19% were frail on admission to ICU. Mean organ support was 2, increased organ supports was correlated with increased age, but not mortality. Average ICU stay was 9 days (range 1–100). Majority of patients were discharged home or to referring hospital, 1 discharged to LTC. ICU mortality was 17% (29); additional hospital stay mortality 16% (26), further 1% (15) patients passed within the year. Total mortality of 42% in a year, patients in their 80’s (46%) and 90’s (100%) had higher mortality rates than patients in their 70’s (24%). Medical admissions were associated with high mortality (64%), but also higher age. Conclusion Increasing numbers of patients over 74, with increasing level of frailty are admitted to ICU. Overall ICU mortality was low, however there was increased mortality associated with the hospital admission. Geriatric expertise to manage multi-morbid frail patients is essential in the high intensity setting to ensure the best outcomes for patients.