Geriatric Assessment at Discharge From the Intensive Care Unit in Patients Aged 75 Years and Older: a Feasibility Study

Overview

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

• Other Geriatric 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.
• Other No geriatric assessment in the 7 days following ICU discharge.
  No geriatric assessment in the 7 days following ICU discharge.

Primary outcome measures

• 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. [Time frame: At 6 Month after ICU discharge]

Secondary outcome measures (12)

• Rate of patients for whom consultation at M6 is carried out. [Time frame: At 6 Month after ICU discharge]
• Frailty, assessed using the Clinical Frailty Scale [Time frame: At 6 Month after ICU discharge]
• Total hospital length of stay [Time frame: At 6 Month after ICU discharge]
• Number of hospitalization [Time frame: At 6 Month after ICU discharge]
• Regular treatment modifications [Time frame: At 6 Month after ICU discharge]
• Modification of place of living [Time frame: At 6 Month after ICU discharge]
• Evolution of the quality of life assessed by the SF-36 questionnary [Time frame: 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. [Time frame: At 6 Month after ICU discharge]
• Evolution of the psychological behaviours through the Covi test evolution for the anxiety component. [Time frame: At 6 Month after ICU discharge]
• Evolution of the Katz-ADL score between initial assessment and month 6 [Time frame: At 6 Month after ICU discharge]
• Evolution of the IADL score between initial assessment and month 6 [Time frame: At 6 Month after ICU discharge]
• Evolution of the locomotor abilities [Time frame: At 6 Month after ICU discharge]

Eligibility criteria

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)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Other

Study locations

France · 1 center

• Service de Médecine Intensive - Réanimation / CHU Strasbourg - France — Strasbourg

Identifiers

NCT: NCT06513130 · 9107

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗