Abstract
Background: The number of people of an extremely advanced age has recently seen a rapid increase in Japan. Thus, an increasing number of such individuals are brought to emergency critical care centers. Many such individuals have poor ability to conduct activities of daily living (ADL) or have dementia, and thus the medical profession often suffers from having to implement intensive therapies. Therefore, the significance of intensive therapy for extremely elderly patients is a timely topic of discussion given their background factors and potential outcomes. Methods: The sample was composed of 66 ICU patients aged 90 or older who had been brought to our facility between January 2009 and December 2011. We retrospectively reviewed their medical records to investigate diseases, patient background factors, operations/treatments after admission, and outcomes. Results: The median age of study participants was 92 years, and 68% were women. Nineteen patients died in the center, 19 were discharged, and 28 were transferred to other centers. The half-year and 1-year survival rates of the 47 discharged/transferred patients were 74.3% and 54.7%, respectively. Significant poor prognostic factors were identified, namely, male, dementia, poor ADL, and residential care. Male gender and poor ADL were found to be independent prognostic factors by multivariate analysis. Discussion: Most extremely elderly patients had a poor long-term outcome, though a few followed a favorable course owing to their treatments. Thus, we question the general significance of intensive therapy for extremely elderly patients in emergency medical centers. Medical practitioners should provide patients and their families with reasonable health care.
