Older critical illness survivors with dual eligibility at risk of functional, cognitive decline

Functional and cognitive decline after an intensive care unit (ICU) hospitalization appears to occur more frequently among dual-eligible older persons than their more advantaged counterparts, reports a study.

“This finding highlights the need to prioritize low-income seniors in rehabilitation and recovery efforts after critical illness and warrants investigation into factors leading to this disparity,” the authors said.

Community-dwelling older adults in the National Health and Aging Trends Study (NHATS) with ICU hospitalizations between 2011 and 2017 were included in this retrospective analysis that evaluated the relationship between socioeconomic disadvantage and decline in function, cognition, and mental health.

The authors assessed socioeconomic disadvantage as dual-eligible Medicare‒Medicaid status. Functional outcome was defined as the count of disabilities in seven activities of daily living and mobility tasks, cognitive outcome as the transition from no or possible to probable dementia, and mental health outcome as the Patient Health Questionnaire-4 score in the NHATS interview after ICU hospitalization.

The analytic sample involved 641 ICU hospitalizations for function, 458 for cognition, and 519 for mental health. Dual eligibility correlated with a 28-percent increase in disability after ICU hospitalization (incidence rate ratio, 1.28, 95 percent confidence interval, 1.00‒1.64) and nearly 10-fold higher likelihood of transitioning to probable dementia (odds ratio, 9.79, 95 percent CI, 3.46‒27.65) after accounting for sociodemographic and clinical characteristics.

Of note, dual eligibility did not contribute to symptoms of depression and anxiety following ICU hospitalization (incidence rate ratio, 1.33, 95 percent CI, 0.99‒1.79).

Limitations of this study included administrative data, variability in timing of baseline and outcome assessments, and proxy selection.