Critical Illness, Frailty, Geriatric Assessment, Older People
Conditions
Brief summary
The number of patients aged over 75 continues to grow, and, according to INSEE, will represent almost 10% of the French population in 2021, an increase of 2.4 points since 2000. This demographic change is also observed in the intensive care units, where admitted patients aged over 80 represent now up to 10-20% of critical care admissions, depending on the facility. The admission of these patients remains controversial, with questions about the benefit to elderly patients, both in terms of in-hospital and distant survival, as well as induced morbidity or subsequent quality of life: functional status is impaired in up to two-thirds of survivors. The challenge of identifying the patients most able to withstand a stay is a major one. Indeed, a stay in intensive care represents a major stress for the organism, due to the acute condition associated with one or more organ failure(s). Bed rest, immobilization and the use of drugs are responsible for formidable complications in the elderly: muscle-wasting, loss of adaptation to physical effort, loss of autonomy, delirium and agitation, all of which have their own long-term impact. While many studies have looked at the prognostic factors on admission of these patients, and the selection of the patient with the greatest probability of surviving the intensive care unit (ICU), improving the outcome of patients who survive to the ICU stay remains a little-investigated subject. However, the impact of physical and psychological disturbances induced by these patients' stay in intensive care is major, and their detection and management could be elements of interest in improving the care of this population. However, the feasibility of carrying out such an assessment immediately after an ICU stay has yet to be evaluated. The aim of this study would be to evaluate the feasibility of a geriatric assessment at the end of the ICU stay (or within 7 days of discharge) and at 6 months. This study is a prospective, randomized, single-center, open-label interventional study.
Interventions
OTHERGeriatric assessment in the 7 days following ICU discharge.
ICU survivors will be assessed by a geriatric physician, in a global (clinical, physical, psyochological and social) approach at the end of the ICU stay or in the 7 days following ICU discharge.
OTHERNo geriatric assessment in the 7 days following ICU discharge.
No geriatric assessment in the 7 days following ICU discharge.
Sponsors
University Hospital, Strasbourg, France
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
75 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients over 75 years of age * Admitted to the intensive care unit, for whatever reason, and having survived their stay, considered as leaving the intensive care unit. * Subjects affiliated to a health insurance scheme * Able to understand the aims and risks of the research and to give dated, signed informed consent, * In the event of confusion on leaving the intensive care unit, a close relative available to give dated, signed informed consent, with the patient's consent collected as soon as his or her condition permits.
Exclusion criteria
* Protected subject as defined by law: safeguard of justice, guardianship or curatorship procedures * Subject moribund, or whose life expectancy as estimated by the clinician in charge is less than 1 month * Patient not living in Bas-Rhin (visit to M6)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Rate of patients for whom a geriatric assessment is carried out between the end of their stay in intensive care and 7 days after discharge. | At 6 Month after ICU discharge |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Frailty, assessed using the Clinical Frailty Scale | At 6 Month after ICU discharge | — |
| Total hospital length of stay | At 6 Month after ICU discharge | — |
| At M6: main organ function assessment | At 6 Month after ICU discharge | — |
| Number of hospitalization | At 6 Month after ICU discharge | — |
| Regular treatment modifications | At 6 Month after ICU discharge | collection of current treatments on admission to intensive care, on discharge from intensive care and hospitalization, and at M6 (prescription) |
| Modification of place of living | At 6 Month after ICU discharge | location (single-family dwelling, retirement home, etc.) |
| Rate of patients for whom consultation at M6 is carried out. | At 6 Month after ICU discharge | — |
| Evolution of the psychological behaviours through the mini Geriatric depression score evolution and the Covi test evolution for the anxiety component. | At 6 Month after ICU discharge | For the interventional arm |
| Evolution of the psychological behaviours through the Covi test evolution for the anxiety component. | At 6 Month after ICU discharge | For the interventional arm |
| Evolution of the Katz-ADL score between initial assessment and month 6 | At 6 Month after ICU discharge | For the interventional arm For the control arm, |
| Evolution of the IADL score between initial assessment and month 6 | At 6 Month after ICU discharge | For the interventional arm For the control arm, |
| Evolution of the locomotor abilities | At 6 Month after ICU discharge | — |
| Evolution of cognition evaluation: mini Mental State Examination | At 6 Month after ICU discharge | — |
| Evolution of the quality of life assessed by the SF-36 questionnary | At 6 Month after ICU discharge | For the interventional arm |
Countries
France
Contacts
Primary ContactJulien DEMISELLE
Outcome results
None listed