Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies
Objectives The influence of age on intensive care unit (ICU) decision-making is complex, and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making, we explored patient-assessed quality of life (QoL) in ICU sur...
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BMJ Publishing Group
2021-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/10/e045086.full |
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| author | Anthony S David Kevin Ariyo Sergio Canestrini Gareth Owen Alex Ruck Keene Sebastian Wolfrum |
| author_facet | Anthony S David Kevin Ariyo Sergio Canestrini Gareth Owen Alex Ruck Keene Sebastian Wolfrum |
| author_sort | Anthony S David |
| collection | DOAJ |
| description | Objectives The influence of age on intensive care unit (ICU) decision-making is complex, and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making, we explored patient-assessed quality of life (QoL) in ICU survivors before the COVID-19 pandemic.Design A systematic review and meta-analysis of cohort studies published between January 2000 and April 2020, of elderly patients admitted to ICUs.Primary and secondary outcome measures We extracted data on self-reported QoL (EQ-5D composite score), demographic and clinical variables. Using a random-effect meta-analysis, we then compared QoL scores at follow-up to scores either before admission, age-matched population controls or younger ICU survivors. We conducted sensitivity analyses to study heterogeneity and bias and a qualitative synthesis of subscores.Results We identified 2536 studies and included 22 for qualitative synthesis and 18 for meta-analysis (n=2326 elderly survivors). Elderly survivors’ QoL was significantly worse than younger ICU survivors, with a small-to-medium effect size (d=0.35 (−0.53 and −0.16)). Elderly survivors’ QoL was also significantly greater when measured slightly before ICU, compared with follow-up, with a small effect size (d=0.26 (−0.44 and −0.08)). Finally, their QoL was also marginally significantly worse than age-matched community controls, also with a small effect size (d=0.21 (−0.43 and 0.00)). Mortality rates and length of follow-up partly explained heterogeneity. Reductions in QoL seemed primarily due to physical health, rather than mental health items.Conclusions The results suggest that the proportionality of age as a determinant of ICU resource allocation should be kept under close review and that subjective QoL outcomes should inform person-centred decision -aking in elderly ICU patients.PROSPERO registration number CRD42020181181. |
| format | Article |
| id | doaj-art-b5d4154b3a9b42cf9cd72e46c44c4384 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-b5d4154b3a9b42cf9cd72e46c44c43842025-08-20T02:18:23ZengBMJ Publishing GroupBMJ Open2044-60552021-10-01111010.1136/bmjopen-2020-045086Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studiesAnthony S David0Kevin Ariyo1Sergio Canestrini2Gareth Owen3Alex Ruck Keene4Sebastian Wolfrum511 Institute of Mental Health, University College London, London, UKDepartment of Psychological Medicine, King`s College London, London, UKCritical Care, King`s College Hospital NHS Foundation Trust, London, UKDepartment of Psychological Medicine, King`s College London, London, UKDepartment of Psychological Medicine, King`s College London, London, UKMedical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig Holstein, Lübeck, GermanyObjectives The influence of age on intensive care unit (ICU) decision-making is complex, and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making, we explored patient-assessed quality of life (QoL) in ICU survivors before the COVID-19 pandemic.Design A systematic review and meta-analysis of cohort studies published between January 2000 and April 2020, of elderly patients admitted to ICUs.Primary and secondary outcome measures We extracted data on self-reported QoL (EQ-5D composite score), demographic and clinical variables. Using a random-effect meta-analysis, we then compared QoL scores at follow-up to scores either before admission, age-matched population controls or younger ICU survivors. We conducted sensitivity analyses to study heterogeneity and bias and a qualitative synthesis of subscores.Results We identified 2536 studies and included 22 for qualitative synthesis and 18 for meta-analysis (n=2326 elderly survivors). Elderly survivors’ QoL was significantly worse than younger ICU survivors, with a small-to-medium effect size (d=0.35 (−0.53 and −0.16)). Elderly survivors’ QoL was also significantly greater when measured slightly before ICU, compared with follow-up, with a small effect size (d=0.26 (−0.44 and −0.08)). Finally, their QoL was also marginally significantly worse than age-matched community controls, also with a small effect size (d=0.21 (−0.43 and 0.00)). Mortality rates and length of follow-up partly explained heterogeneity. Reductions in QoL seemed primarily due to physical health, rather than mental health items.Conclusions The results suggest that the proportionality of age as a determinant of ICU resource allocation should be kept under close review and that subjective QoL outcomes should inform person-centred decision -aking in elderly ICU patients.PROSPERO registration number CRD42020181181.https://bmjopen.bmj.com/content/11/10/e045086.full |
| spellingShingle | Anthony S David Kevin Ariyo Sergio Canestrini Gareth Owen Alex Ruck Keene Sebastian Wolfrum Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies BMJ Open |
| title | Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies |
| title_full | Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies |
| title_fullStr | Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies |
| title_full_unstemmed | Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies |
| title_short | Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies |
| title_sort | quality of life in elderly icu survivors before the covid 19 pandemic a systematic review and meta analysis of cohort studies |
| url | https://bmjopen.bmj.com/content/11/10/e045086.full |
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