Executive Function, Dexterity, and Discharge Disposition in Older Intensive Care Unit Survivors

2020 ◽  
Vol 29 (6) ◽  
pp. 484-488
Author(s):  
Maya N. Elías ◽  
Cindy L. Munro ◽  
Zhan Liang
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Executive Function ◽  
Cognitive Flexibility ◽  
Motor Coordination ◽  
Functional Decline ◽  
Dimensional Change ◽  
Fine Motor ◽  
Discharge Disposition

Background Dexterity is a component of motor function. Executive function, a subdomain of cognition, may affect dexterity in older adults recovering from critical illness after discharge from an intensive care unit (ICU). Objectives To explore associations between executive function (attention and cognitive flexibility) and dexterity (fine motor coordination) in the early post-ICU period and examine dexterity by acuity of discharge disposition. Methods The study involved 30 older adults who were functionally independent before hospitalization, underwent mechanical ventilation in the ICU, and had been discharged from the ICU 24 to 48 hours previously. Dexterity was evaluated with the National Institutes of Health Toolbox (NIHTB) Motor Battery 9-Hole Pegboard Dexterity Test (PDT); attention, with the NIHTB Cognition Battery Flanker Inhibitory Control and Attention Test (FICAT); and cognitive flexibility, with the NIHTB Cognition Battery Dimensional Change Card Sort Test (DCCST). Exploratory regression was used to examine associations between executive function and dexterity (fully corrected T scores). Independent-samples t tests were used to compare dexterity between participants discharged home and those discharged to a facility. Results FICAT (β = 0.375, P = .03) and DCCST (β = 0.698, P = .001) scores were independently and positively associated with PDT scores. Further, PDT scores were worse among participants discharged to a facility than among those discharged home (mean [SD], 26.71 [6.14] vs 36.33 [10.30]; t24 = 3.003; P = .006). Conclusions Poor executive function is associated with worse dexterity; thus, dexterity may be a correlate of both post-ICU cognitive impairment and functional decline. Performance on dexterity tests could identify frail older ICU survivors at risk for worse discharge outcomes.

scholarly journals Baseline and clinical characteristics of older adults admitted to the intensive care unit through the emergency room: Analysis based on age groups

2019 ◽  
pp. 102490791988044
Author(s):  
Ye Lim Lee ◽  
Sang Ook Ha ◽  
Young Sun Park ◽  
Jeong Hyeon Yi ◽  
Sun Beom Hur ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Age Groups ◽  
Discharge Disposition ◽  
Neurologic Outcomes ◽  
Diagnosis Of Cancer ◽  
Overall Mortality

Background and Objectives: There is currently no consensus on the criteria for admitting older adults to the intensive care unit. Methods: This single-center retrospective study evaluated the baseline and clinical characteristics of older adults admitted to the intensive care unit between January 2017 and June 2017; patients were analyzed according to their age group. Factors associated with in-hospital mortality were specifically determined using logistic regression analysis. Results: Among 582 patients included in the present study, 34.2%, 46.6%, and 19.2% were aged 65–74, 75–84, and over 84 years, respectively. In terms of clinical outcomes, although there were no significant differences in the length of intensive care unit and hospital stay and intensive care unit mortality, significant differences were observed in terms of in-hospital mortality, hospital discharge disposition, and neurologic outcomes at discharge ( p = 0.039, p = 0.005, and p = 0.032, respectively). Predictive factors for in-hospital mortality were age (⩾85 years), initial mental status (stupor to coma), a Korean Triage and Acuity Scale level of 1, underlying diagnosis of cancer, abdominal pain or discomfort, apnea, and a chief compliant of dyspnea. Conclusion: Compared to those aged 65–84 years, in-hospital mortality was 1.96-fold higher in those aged over 84 years. However, the overall mortality in our cohort was not considerably different from that of the younger population. Intensive care unit admission should be considered in selected older adults after evaluating the risk factors for mortality.

The relationship between executive function and fine motor control in young and older adults

2017 ◽  
Vol 51 ◽  
pp. 41-50 ◽  
Author(s):  
Emily J. Corti ◽  
Andrew R. Johnson ◽  
Hayley Riddle ◽  
Natalie Gasson ◽  
Robert Kane ◽  
...  
Keyword(s):  
Older Adults ◽  
Motor Control ◽  
Executive Function ◽  
Fine Motor ◽  
Fine Motor Control ◽  
The Relationship

Abstract 301: Differential Outcomes for Geriatric Patients in Cardiac Intensive Care Unit Compared to Medical Intensive Care Unit

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Caroline Ong ◽  
Albert Lui ◽  
John A Dodson ◽  
Jordan B Strom ◽  
Carlos Alviar
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Older Age ◽  
Icu Mortality ◽  
Differential Outcomes ◽  
Medical Intensive Care ◽  
Cardiac Intensive Care

Background: The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU. Methods: All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality. Results: We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients >75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure). Conclusion: Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.

scholarly journals High-Intensity Interval Training Improves Cognitive Flexibility in Older Adults

2020 ◽  
Vol 10 (11) ◽  
pp. 796
Author(s):  
Said Mekari ◽  
Heather F. Neyedli ◽  
Sarah Fraser ◽  
Myles W. O’Brien ◽  
Ricardo Martins ◽  
...  
Keyword(s):  
Older Adults ◽  
Executive Function ◽  
Cardiorespiratory Fitness ◽  
Cognitive Flexibility ◽  
Stroop Task ◽  
Interval Training ◽  
Moderate Intensity ◽  
High Intensity Interval Training ◽  
Continuous Training ◽  
High Intensity Interval

Introduction: Regular aerobic exercise is associated with better executive function in older adults. It is unclear if high-intensity-interval-training (HIIT) elicits moderate-intensity continuous training (MICT) or resistance training (RT). We hypothesized that HIIT would augment executive function more than MICT and RT. Methods: Sixty-nine older adults (age: 68 ± 7 years) performed six weeks (three days/week) of HIIT (2 × 20 min bouts alternating between 15 s intervals at 100% of peak power output (PPO) and passive recovery (0% PPO); n = 24), MICT (34 min at 60% PPO; n = 19), or whole-body RT (eight exercise superior improvements in executive function of older adults than moderate-intensity-continuous-training, 2 × 10 repetitions; n = 26). Cardiorespiratory fitness (i.e., V˙O2max) and executive function were assessed before and after each intervention via a progressive maximal cycle ergometer protocol and the Stroop Task, respectively. Results: The V˙O2max findings revealed a significant group by time interaction (p = 0.001) in which all groups improved following training, but HIIT and MICT improved more than RT. From pre- to post-training, no interaction in the naming condition of the Stroop Task was observed (p > 0.10). However, interaction from pre- to post-training by group was observed, and only the HIIT group exhibited a faster reaction time (from 1250 ± 50 to 1100 ± 50 ms; p < 0.001) in switching (cognitive flexibility). Conclusion: Despite similar improvements in cardiorespiratory fitness, HIIT, but not MICT nor RT, enhanced cognitive flexibility in older adults. Exercise programs should consider using HIIT protocols in an effort to combat cognitive decline in older adults.

scholarly journals Level of acuity, severity and intensity of care of adults and older adults admitted to the Intensive Care Unit

2019 ◽  
Vol 53 ◽  
Author(s):  
Renata Eloah de Lucena Ferretti-Rebustini ◽  
Nilmar da Silva Bispo ◽  
Winnie da Silva Alves ◽  
Thiago Negreiro Dias ◽  
Cristiane Moretto Santoro ◽  
...  
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Group Method ◽  
Predictive Capacity ◽  
Organic Dysfunction ◽  
Intensity Of Care ◽  
Correlation Tests ◽  
The City

ABSTRACT Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults.

Management and Outcomes of Laryngeal Injuries in the Pediatric Population

2011 ◽  
Vol 120 (12) ◽  
pp. 787-795 ◽  
Author(s):  
Douglas Sidell ◽  
Abie H. Mendelsohn ◽  
Nina L. Shapiro ◽  
Maie St. John
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Procedures ◽  
Data Bank ◽  
Fracture Repair ◽  
Laryngeal Trauma ◽  
Discharge Disposition ◽  
National Trauma ◽  
Organ Systems ◽  
National Trauma Data Bank

Objectives: Pediatric laryngeal trauma is an uncommon event. The purpose of this study was to identify outcomes following surgical procedures for pediatric laryngeal trauma, and to provide an in-depth review of the literature. Methods: The National Trauma Data Bank was utilized to identify pediatric laryngeal trauma incidents with admission years 2002 through 2006. Patient demographics, injury type, surgical procedures, hospital and intensive care unit durations, ventilator duration, and discharge disposition were abstracted. Results: There were 69 laryngeal trauma incidents identified, with a median patient age of 12.8 years and an overall mortality rate of 8.7%. Laryngeal injury was frequently blunt-force in nature (82.8%) and often occurred in conjunction with trauma to multiple organ systems (76.8%). Tracheotomy (16 procedures), laryngeal suturing (13 procedures), and laryngeal fracture repair (10 procedures) were the most frequent procedures identified. Laryngeal fracture repair was noted to increase the overall hospital duration (p = 0.040). The communication scores were affected only by tracheotomy (p = 0.013). Surgical intervention did not significantly affect the frequency of home discharge. Conclusions: Pediatric laryngeal trauma is an uncommon event that can be evaluated with the National Trauma Data Bank. Although patients who undergo laryngeal fracture repair appear to have an increased duration of hospitalization, patients who undergo tracheotomy or laryngeal suturing do not have increased durations of ventilator dependence, stay in an intensive care unit, or hospitalization.

Predictors of Functional Decline Among Older Intensive Care Unit (ICU) Survivors

2019 ◽  
Author(s):  
L.E. Ferrante ◽  
T.E. Murphy ◽  
B.C. Vander Wyk ◽  
L.S. Leo-Summers ◽  
M.A. Pisani ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Functional Decline

scholarly journals Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission

2020 ◽  
Vol 245 ◽  
pp. 492-499 ◽  
Author(s):  
Jessica A. Bowman ◽  
Gregory J. Jurkovich ◽  
Daniel K. Nishijima ◽  
Garth H. Utter
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Rib Fractures
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