Trends in Geriatric Conditions Among Older Adults Admitted to US Intensive Care Units between 1998-2015.

Older adults are increasingly admitted to the intensive care unit (ICU) and those with disabilities, dementia, frailty and multimorbidity are vulnerable to adverse outcomes. Little is known about how pre-existing geriatric conditions have changed over time.How have changes in disability, dementia, frailty, and multimorbidity in older adults admitted to the ICU changed from 1998-2015?Medicare-linked Health and Retirement Survey (HRS) data identifying patients age ≥65 years admitted to an ICU between 1998 and 2015. ICU admission was the unit of analysis. Year of ICU admission was the exposure. Disability, dementia, frailty and multimorbidity were identified based on responses to HRS surveys prior to ICU admission. Disability represented the need for assistance with ≥1 activity of daily living. Dementia used cognitive and functional measures. Frailty included deficits in ≥2 domains (physical, nutritive, cognitive or sensory function). Multimorbidity represented ≥3 self-reported chronic diseases. Time trends in geriatric conditions were modeled as a function of year of ICU admission and adjusted for age, gender, race/ethnicity and proxy interview status.Across 6084 ICU patients, age at admission increased from 77.6 years (95% CI, 76.7-78.4) in 1998 to 78.7 years (95% CI, 77.5-79.8) in 2015 (p<0.001 for trend). The adjusted proportion of ICU admissions with pre-existing disability rose from 15.5% (95% CI, 12.1-18.8%) in 1998 to 24.0% (95% CI, 18.5-29.6%) in 2015 (p=0.001). Rates of dementia did not change significantly (p=0.21). Frailty increased from 36.6% (95% CI, 30.9-42.3%) in 1998 to 45.0% (95% CI, 39.7-50.2%) in 2015 (p=0.04); multimorbidity rose from 54.4% (95% CI, 49.2-59.7%) in 1998 to 71.8% (95% CI, 66.3-77.2%) in 2015 (p<0.001).Rates of pre-existing disability, frailty, and multimorbidity in older adults admitted to ICUs increased over time. Geriatric principles need to be deeply integrated into the ICU setting.