Impaired Pre‐Critical Illness Quality of Life in Elderly <scp>ICU</scp> Patients

BACKGROUND: The EuroQol EQ-5D-5L is recommended to assess health-related quality of life (HRQoL) in intensive care unit (ICU) survivors and included in many national ICU registries at the time of follow-up. While establishing baseline HRQoL in elderly ICU survivors is important for informing follow-up services, it is rarely performed in clinical practice. We aimed to compare pre-critical illness EQ-5D-5L scores with Norwegian general population norms in elderly adults. METHODS: We conducted a prospective multicenter observational study across five ICUs to assess pre-critical illness HRQoL in mechanically ventilated patients ≥ 65 years old using EQ-5D-5L. Data assessing HRQoL before critical illness were collected during the ICU stay, obtained primarily from proxies or via patient self-report where feasible. Response frequencies for the EQ-5D-5L dimensions, EQ-5D-5L index, and EQ VAS scores were compared with those for general population norms after random exact matching for age and sex. The five dimensions were dichotomized into the presence of health problems or not. RESULTS: Based on responses from 345 participants, the ICU population had a baseline mean EQ-5D-5L index of 0.78 (±0.24), an EQ VAS of 61 (±23), and 60 ICU patients reported no problems in any of the five domains. The norm population had a mean EQ-5D-5L index of 0.88 (±0.17), an EQ VAS of 79 (±20), and 107 had no problems in any of the five dimensions. Pearson chi-square or two-tailed t-tests showed significantly (p < 0.05) poorer scores for all EQ-5D-5L scores for the ICU population compared to the norm data. The greatest differences were found in the younger age group 65-72 years. Comorbidity was a strong independent predictor of baseline health status, whereas chronological age showed no significant association. CONCLUSION: Compared to the age- and sex-matched general population, the elderly ICU population had poorer HRQoL before critical illness occurred. To improve the interpretation of post-ICU assessments, baseline EQ-5D-5L should be assessed at ICU admission. The results highlight the need for studies in ICU patients that include HRQoL as part of a prospective study design. EDITORIAL COMMENT: This study presents pre-ICU quality of life scoring for older cases requiring mechanical ventilation. Compared to a matched non-ICU cohort, significant lower reported quality of life scoring was observed.