Quality of Life in elderly ICU survivors: A Rapid Systematic Review and Meta-Analysis of Cohort Studies

Abstract

ABSTRACTBACKGROUNDThe influence of age upon intensive care unit (ICU) decision-making is complex and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making we explored patient-assessed quality of life (QoL) in ICU survivors.METHODSWe conducted a rapid database search of cohort studies published between January 2000 to April 2020, of elderly patients admitted to ICUs. We extracted data on self-reported QoL (EQ-5D composite score), study characteristics and demographic and clinical variables. Using a random-effects model, we then compared QoL scores at follow-up to scores either before admission, age-matched population controls or younger ICU survivors. Finally, we conducted follow-up quantitative analyses to explore potential moderators of these effects, and a qualitative synthesis of QoL subscores. A study protocol was registered prospectively on PROSPERO, ID: CRD42020181181.FINDINGSOur database search found 2536 studies and from these we reviewed 376 potentially relevant full texts. 21 of these studies met the inclusion criteria for qualitative synthesis and 18 were also included in the meta-analysis (N= 2090 elderly adults). The follow-up periods ranged between 3-100 months. There was no significant difference in the elderly’s QoL scores between one month before ICU and follow-up, or between follow-up and age-matched community controls. QoL in elderly ICU survivors was significantly worse than younger ICU survivors, with a small-to-medium effect size (d= .33 [.10 to .55]). Mortality rates and length of follow up were possible intermediary factors. The qualitative synthesis suggested that any reductions in QoL were primarily due to reductions in physical health, rather than mental health items.INTERPRETATIONOverall, elderly ICU patients did not experience significantly impaired QoL at follow up, compared to before ICU or their healthy peers. Elderly patients who survive ICU can be expected to have slightly worse QoL compared to younger patients, especially in the longterm. The results suggest that the proportionality of age as a determinant of (population level) ICU resource allocation should be kept under close review and that subjective QoL outcomes (not only objective survival data) should inform person-centred decision making in elderly ICU patients.DECLARATIONS OF INTERESTAlex Ruck Keene is an adviser on the Faculty of Intensive Care Medicine’s Legal and Ethical Policy Unit. We report no other competing interests.