Early Post‐Intensive Care Syndrome among Older Adult Sepsis Survivors Receiving Home Care

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 67; no. 3; pp. 520 - 526
• Main Authors: Riegel, Barbara, Huang, Liming, Mikkelsen, Mark E., Kutney‐Lee, Ann, Hanlon, Alexandra L., Murtaugh, Christopher M., Bowles, Kathryn H.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2019
• Subjects: Activities of Daily Living; Aftercare - methods; Aftercare - psychology; Aftercare - statistics & numerical data; Aged; Cognition; Cognitive ability; cognitive dysfunction; critical care; Critical Care - methods; Dementia disorders; Disability; Disability Evaluation; Female; Geriatric Assessment - methods; home care services; Home Care Services - statistics & numerical data; Humans; Intensive care; Intensive Care Units - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Medicare; Mental disorders; Mental health; Older people; Outcome and Process Assessment, Health Care; Patient Discharge - statistics & numerical data; Physical Functional Performance; post‐intensive care syndrome; Risk Factors; Sepsis; Sepsis - complications; Sepsis - epidemiology; Sepsis - therapy; Survivors - psychology; United States - epidemiology; United States; activities of daily living; mental health; critical care; post-intensive care syndrome; home care services; cognitive dysfunction; sepsis
• DOI: 10.1111/jgs.15691
• ISSN: 0002-8614

BACKGROUND/OBJECTIVES New or worsened disabilities in functional, cognitive, or mental health following an intensive care unit (ICU) stay are referred to as post‐intensive care syndrome (PICS). PICS has not been described in older adults receiving home care. Our aim was to examine the relationship between length of ICU stay and PICS among older adults receiving home care. We expected that patients in the ICU for 3 days or longer would demonstrate significantly more disability in all three domains on follow‐up than those not in the ICU. A secondary aim was to identify patient characteristics increasing the odds of disability. DESIGN Retrospective cohort study. SETTING Hospitalization for sepsis in the United States. PARTICIPANTS A total of 21 520 Medicare patients receiving home care and reassessed a median of 1 day (interquartile range 1‐2 d) after hospital discharge. MEASUREMENTS PICS was defined as a decline or worsening in one or more of 16 indicators tested before and after hospitalization using OASIS (Home Health Outcome and Assessment Information Set) and Medicare claims data. RESULTS The sample was predominantly female and white. All had sepsis, and most (81.8%) had severe sepsis. In adjusted models, an ICU stay of 3 days or longer, compared with no ICU stay, increased the odds of physical disability. Overall, the declines were modest and found in specific activities of daily living (16% for feeding and lower body dressing to 26% for oral medicine management). No changes were identified in cognition or mental health. Significant determinants of new or worsened physical disabilities were sepsis severity, older age, depression, frailty, and dementia. CONCLUSION Older adults receiving home care who develop sepsis and are in an ICU for 3 days or longer are likely to develop new or worsened physical disabilities. Whether these disabilities remain after the early postdischarge phase requires further study. J Am Geriatr Soc 67:520–526, 2019.