Disability in activities of daily living, depression, and quality of life among older medical ICU survivors: a prospective cohort study.

Publisher: BioMed Central Country of Publication: England NLM ID: 101153626 Publication Model: Electronic Cited Medium: Internet ISSN: 1477-7525 (Electronic) Linking ISSN: 14777525 NLM ISO Abbreviation: Health Qual Life Outcomes Subsets: MEDLINE

Original Publication: [London] : BioMed Central, c2003-

Activities of Daily Living/*psychology ; Depression/*psychology ; Quality of Life/*psychology ; Survivors/*psychology; APACHE ; Activities of Daily Living/classification ; Aged ; Comorbidity ; Connecticut ; Critical Illness/psychology ; Depression/etiology ; Persons with Disabilities/psychology ; Female ; Humans ; Intensive Care Units/statistics & numerical data ; Male ; Prospective Studies ; Regression Analysis ; Sickness Impact Profile ; Time Factors

Background: Accurate measurement of quality of life in older ICU survivors is difficult but critical for understanding the long-term impact of our treatments. Activities of daily living (ADLs) are important components of functional status and more easily measured than quality of life (QOL). We sought to determine the cross-sectional associations between disability in ADLs and QOL as measured by version one of the Short Form 12-item Health Survey (SF-12) at both one month and one year post-ICU discharge.
Methods: Data was prospectively collected on 309 patients over age 60 admitted to the Yale-New Haven Hospital Medical ICU between 2002 and 2004. Among survivors an assessment of ADL's and QOL was performed at one month and one-year post-ICU discharge. The SF-12 was scored using the version one norm based scoring with 1990 population norms. Multivariable regression was used to adjust the association between ADLs and QOL for important covariates.
Results: Our analysis of SF-12 data from 110 patients at one month post-ICU discharge showed that depression and ADL disability were associated with decreased QOL. Our model accounted for 17% of variability in SF12 physical scores (PCS) and 20% of variability in SF12 mental scores (MCS). The mean PCS of 37 was significantly lower than the population mean whereas the mean MCS score of 51 was similar to the population mean. At one year mean PCS scores improved and ADL disability was no longer significantly associated with QOL. Mortality was 17% (53 patients) at ICU discharge, 26% (79 patients) at hospital discharge, 33% (105 patients) at one month post ICU admission, and was 45% (138 patients) at one year post ICU discharge.
Conclusions: In our population of older ICU survivors, disability in ADLs was associated with reduced QOL as measured by the SF-12 at one month but not at one year. Although better markers of QOL in ICU survivors are needed, ADLs are a readily observable outcome. In the meantime, clinicians must try to offer realistic estimates of prognosis based on available data and resources are needed to assist ICU survivors with impaired ADLs who wish to maintain their independence. More aggressive diagnosis and treatment of depression in this population should also be explored as an intervention to improve quality of life.

JAMA. 1963 Sep 21;185:914-9. (PMID: 14044222)
Intensive Care Med. 2005 May;31(5):611-20. (PMID: 15803303)
Health Qual Life Outcomes. 2004 Sep 21;2:52. (PMID: 15383148)
Arch Gerontol Geriatr. 2010 May-Jun;50(3):e36-40. (PMID: 19523697)
Psychol Med. 1994 Feb;24(1):145-53. (PMID: 8208879)
Intensive Care Med. 2004 Apr;30(4):647-54. (PMID: 14985964)
Crit Care Med. 2005 Jun;33(6):1371-6. (PMID: 15942358)
N Engl J Med. 1996 Mar 28;334(13):835-40. (PMID: 8596551)
Crit Care Clin. 2009 Jul;25(3):615-28, x. (PMID: 19576534)
N Engl J Med. 2003 Feb 20;348(8):683-93. (PMID: 12594312)
Crit Care Med. 2000 Oct;28(10):3389-95. (PMID: 11057791)
J Chronic Dis. 1987;40(5):373-83. (PMID: 3558716)
Curr Opin Crit Care. 2007 Oct;13(5):476-81. (PMID: 17762222)
Crit Care Med. 1985 Oct;13(10):818-29. (PMID: 3928249)
Crit Care Med. 2009 Nov;37(11):2888-94; quiz 2904. (PMID: 19770733)
Intensive Care Med. 2006 Jul;32(7):1045-51. (PMID: 16791667)
JAMA. 1993 Jun 23-30;269(24):3119-23. (PMID: 8505814)
Crit Care Med. 2001 Jul;29(7):1370-9. (PMID: 11445689)
Intensive Care Med. 2003 Nov;29(11):1895-901. (PMID: 14530857)
Crit Care. 2010;14(1):R2. (PMID: 20064197)
J Gen Intern Med. 1997 Jul;12(7):439-45. (PMID: 9229283)
Crit Care Med. 2007 Mar;35(3):827-35. (PMID: 17255863)

K23AG23023 United States AG NIA NIH HHS; P30AG021342 United States AG NIA NIH HHS

Date Created: 20110208 Date Completed: 20110711 Latest Revision: 20250103

20250114

PMC3041645

10.1186/1477-7525-9-9

21294911