Geriatric intensive care unit
Encyclopedia
Geriatric intensive care unit is a special type of intensive care unit
dedicated to management of critically ill elderly.
Geriatric intensive care unit's goal
is to restore physiologic stability, prevent complications, maintain comfort and safety, and preserve pre-illness functional ability and quality of life (QOL) in older adults admitted to critical-care units.
diseases is unlike adults or pediatrics diseases, particularly for the critically ill. Not all critical care
physicians are fully oriented to the peculiarties of geriatric patients.
One definition of a critically ill older adult is:
. However, when the urgent episode subsides, general practice guidelines and clinical approaches may be inappropriate in older adults who often have less physiological reserve. Further, specific geriatric syndromes, medication issues and problems that can be prevented if they are anticipated. Sleep disorders are prevalent in the elderly. During a critical care episode, sleeping and waking cycles are disturbed. Because of the noise in an ICU, less sleep and more noise may trigger delirium.
Altered eating
and feeding
patterns are common in geriatric intensive care units. Enteral
tube feeding and total parenteral nutrition
have many advantages and disadvantages.
Foley catheter
s are regularly inserted in patients in the intensive care unit to monitor fluid balance, this should be changed. urinary catheters are known to cause urinary tract infections, which are potentially lethal to the elderly. Thus, when possible, catheters should be avoided in the ICU. In addition, the use of incontinence
undergarments should be avoided, given the propensity for skin irritation and breakdown.
The ICU environment has been linked to delirium
in the elderly. Disorientation to time or place because of overstimulation, pain
and metabolic imbalances frequently results in cognitive changes. Optimally, critical care nurses must obtain a baseline mental status on the older patient upon admission and follow the changes through the use of a standardized assessment instrument such as a Mini-Mental State Examination
. Early detection and intervention can reduce the use of either physical or chemical restraints.
, but such models have been inadequately validated. Age alone may not necessarily be a predictor
of short-term or long-term outcome in the older patient who is critically ill. Rationing decisions for intake to a critical care bed during periods of reduced availability may be based on triage factors of uncertain importance.
Intensive Care Unit
thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...
dedicated to management of critically ill elderly.
Geriatric intensive care unit's goal
Goal
A goal is an objective, or a projected computation of affairs, that a person or a system plans or intends to achieve.Goal, GOAL or G.O.A.L may also refer to:Sport...
is to restore physiologic stability, prevent complications, maintain comfort and safety, and preserve pre-illness functional ability and quality of life (QOL) in older adults admitted to critical-care units.
Origin
Geriatric intensive care units appeared in response to the world's population aging. Managing GeriatricsGeriatrics
Geriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
diseases is unlike adults or pediatrics diseases, particularly for the critically ill. Not all critical care
Critical care
Critical care may refer to:* Critical care medicine or intensive-care medicine, a branch of medicine concerned with life support for critically ill patients* "Critical Care" , an episode of the TV series...
physicians are fully oriented to the peculiarties of geriatric patients.
One definition of a critically ill older adult is:
a person, age 65 or older, who is currently experiencing or at risk for some form of physiologic instability or alteration warranting urgent or emergent, advanced nursing/medical interventions and monitoring.
- More than half (55.8%) of all ICU days are incurred by patients older than 65.
- Older adults are living longer, are more racially and ethnically diverse, often have multiple chronic conditions, and more than one-quarter report difficulty performing one or more activities of daily living (ADLs). These factors may affect both the course and outcome of critical illness.
- Once hospitalized for a life-threatening illness, older adults often:
- Experience high ICU, hospital, and long-term crude mortality rates.
- Are at risk for deterioration in functional ability and post-discharge institutional care.
- Older age is a factor that could conceptually lead to:
- Potential bias in refusing ICU admission.
- The decision to withhold mechanical ventilation, surgery, or dialysis.
- An increased likelihood of an established resuscitation directive.
- Most critically ill older adults:
- Demonstrate resiliency.
- Report being satisfied with their QOL post-discharge.
- Would reaccept ICU care and mechanical ventilation if needed.
- Chronologic age alone is not an acceptable or accurate predictor of poor outcomes after critical illness.
- Factors that may influence an older adult’s ability to survive a catastrophic illness include:
- Severity of illness
- Nature and extent of co-morbidities
- Diagnosis, reason for/duration of mechanical ventilation
- Complications length of ICU/hospital stay.
Practice issues
The most important effort in critical care practice is maintaining physiological function and restoring homeostasisHomeostasis
Homeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
. However, when the urgent episode subsides, general practice guidelines and clinical approaches may be inappropriate in older adults who often have less physiological reserve. Further, specific geriatric syndromes, medication issues and problems that can be prevented if they are anticipated. Sleep disorders are prevalent in the elderly. During a critical care episode, sleeping and waking cycles are disturbed. Because of the noise in an ICU, less sleep and more noise may trigger delirium.
Altered eating
Eating
Eating is the ingestion of food to provide for all organisms their nutritional needs, particularly for energy and growth. Animals and other heterotrophs must eat in order to survive: carnivores eat other animals, herbivores eat plants, omnivores consume a mixture of both plant and animal matter,...
and feeding
Feeding
Feeding is the process by which organisms, typically animals, obtain food. Terminology often uses either the suffix -vore from Latin vorare, meaning 'to devour', or phagy, from Greek φαγειν, meaning 'to eat'.-Evolutionary history:...
patterns are common in geriatric intensive care units. Enteral
Enteral
In pharmacology, Enteral is a term used to describe routes of drug administration that involve absorption of the drug through the gastrointestinal tract. The term may also be used to describe something as residing in the gastrointestinal tract...
tube feeding and total parenteral nutrition
Total parenteral nutrition
Parenteral nutrition is feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulae that contain nutrients such as glucose, amino acids, lipids and added vitamins and dietary minerals...
have many advantages and disadvantages.
Foley catheter
Foley catheter
A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
s are regularly inserted in patients in the intensive care unit to monitor fluid balance, this should be changed. urinary catheters are known to cause urinary tract infections, which are potentially lethal to the elderly. Thus, when possible, catheters should be avoided in the ICU. In addition, the use of incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
undergarments should be avoided, given the propensity for skin irritation and breakdown.
The ICU environment has been linked to delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...
in the elderly. Disorientation to time or place because of overstimulation, pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
and metabolic imbalances frequently results in cognitive changes. Optimally, critical care nurses must obtain a baseline mental status on the older patient upon admission and follow the changes through the use of a standardized assessment instrument such as a Mini-Mental State Examination
Mini-mental state examination
The mini–mental state examination or Folstein test is a brief 30-point questionnaire test that is used to screen for cognitive impairment. It is commonly used in medicine to screen for dementia...
. Early detection and intervention can reduce the use of either physical or chemical restraints.
Ethical issues
Geriatric critical care can give rise to ethical issues. Despite the pervasive conceptual emphasis on evidence-based health care, there is insufficient research to guide the Geriatrics critical care clinician, which leaves substantial subjectivity in crucial decisions. Outcome prediction models have been proposed, with age as one of numerous variablesVariable (mathematics)
In mathematics, a variable is a value that may change within the scope of a given problem or set of operations. In contrast, a constant is a value that remains unchanged, though often unknown or undetermined. The concepts of constants and variables are fundamental to many areas of mathematics and...
, but such models have been inadequately validated. Age alone may not necessarily be a predictor
Predictor
Predictor may refer to:* a predictor variable, also known as an independent variable* the Kerrison Predictor, a military fire-control computer* something which makes a prediction* a branch predictor, a part of many modern processors...
of short-term or long-term outcome in the older patient who is critically ill. Rationing decisions for intake to a critical care bed during periods of reduced availability may be based on triage factors of uncertain importance.
External links
- Acute Emergencies and Critical Care of the Geriatric Patient (book) http://books.google.com/books?id=O4vVcpaZ5mcC&lpg=PA203&ots=-1GUGOnlwm&dq=9780824746537&pg=PA8#v=onepage&q&f=false
- Geriatric Critical Care Nursing Research (GCCNR) Group. http://www.geriatricnursing.org/resources/additional-resources.asp