Health Equity and Critical Care Survivorship: Where Do We Go From Here?
| Autor: | Timothy Girard, Leslie Scheunemann, Kelly Potter |
|---|---|
| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Ann Intern Med |
| ISSN: | 1539-3704 0003-4819 |
| DOI: | 10.7326/m22-0726 |
| Popis: | BACKGROUND: Older adults admitted to an intensive care unit (ICU) are at risk of developing impairments in function, cognition, and mental health. It is not known whether socioeconomically disadvantaged older persons are at greater risk for these impairments than their less vulnerable counterparts. OBJECTIVE: To evaluate the association between socioeconomic disadvantage and decline in function, cognition, and mental health among older survivors of an ICU hospitalization. DESIGN: Retrospective analysis of a longitudinal cohort study. SETTING: Community-dwelling older adults in the National Health and Aging Trends Study (NHATS). PARTICIPANTS: NHATS participants with ICU hospitalizations between 2011–2017. MEASUREMENTS: Socioeconomic disadvantage was assessed as dual-eligible Medicare-Medicaid status. The outcome of function was defined as the count of disabilities in 7 activities of daily living and mobility tasks, the cognitive outcome as the transition from no or possible to probable dementia, and the mental health outcome as the Patient Health Questionnaire-4 (PHQ-4) score in the NHATS interview following ICU hospitalization. The analytic sample included 641 ICU hospitalizations for function, 458 for cognition, and 519 for mental health. RESULTS: After accounting for sociodemographic and clinical characteristics, dual-eligibility was associated with a 28% increase in disability after ICU hospitalization (incidence rate ratio:1.28; 95% CI:1.00,1.64); and nearly 10-fold greater odds of transitioning to probable dementia (odds ratio:9.79; 95% CI:3.46,27.65). Dual-eligibility was not associated with symptoms of depression and anxiety following ICU hospitalization (incidence rate ratio:1.33; 95% CI: 0.99,1.79). LIMITATIONS: Administrative data, variability in timing of baseline and outcome assessments, proxy selection. CONCLUSIONS: Dual-eligible older persons are at greater risk of decline in function and cognition after an ICU hospitalization than their more advantaged counterparts. This finding highlights the need to prioritize low-income seniors in rehabilitation and recovery efforts after critical illness and warrants investigation into factors leading to this disparity. PRIMARY FUNDING SOURCE: National Institute of Aging |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|