A little over a decade ago, Ken Covinsky wrote a GeriPal post about a Jack Iwashyna JAMA study finding that older adults who survive sepsis are likely to develop new functional and cognitive deficits after they leave the hospital. To this day, Ken’s post is still one of the most searched and viewed posts on GeriPal.

This idea that for critically ill patients in the ICU, geriatric conditions like disability, frailty, multimorbidity, and dementia should be viewed through a wider lens of what patients are like before and after the ICU event was transformative for our two guests today. Julien Cobert just published a study in Chest finding that even after accounting for the rising age of patients admitted to the ICU, rates of pre-existing disability, frailty, and multimorbidity increased over about a ten year period. Rise in these conditions occurred over a decade - what happens over the next 10, 20, 30 years?

And Lauren Ferrante has found in a study published in JAMA Internal Medicine that trajectories of disability in the year prior to ICU admission were highly predictive of disability post-ICU, on the same order of magnitude as mechanical ventilation. In a separate study in Chest, Lauren found pre-ICU frailty was associated with post-ICU disability and new nursing home admission. Lauren uses her magic wand to address the measurement issue: we’re not measuring function, frailty, and cognition routinely in hospitalized older adults. We wouldn’t dream of not measuring oxygen saturation, yet function, which is highly predictive of outcomes older adults care about, many hospitals hardly measure.

Additional links:

GeriPal podcast with Lauren Ferrante and Nathan Brummel on geriatricizing the ICU
GeriPal podcast with Tom Gill on the Precipitating Events Study, distressing symptoms, disability, and hospice
GeriPal podcast with Linda Fried on frailty
Shunichi Nakagawa’s Tweet that went viral on responding a patient request to drink ice water before death.

And a note- on the podcast you’ll hear a drum track on the song (!). I’m taking lessons with an audio producer in LA who is helping me to learn some new Logic Pro post-production skills. Bear with me! I’m having fun working on these songs from home during COVID.

Aging and the ICU: Podcast with Lauren Ferrante and Julien Cobert

GeriPal - A Geriatrics and Palliative Medicine Podcast