Your 80—something—year—old dad has just been admitted to the hospital’s intensive care unit after a stroke or a heart attack. Now, he’s surrounded by blinking monitors, with tubes in his arms and alarms going off around him.
You’re scared and full of uncertainty. Will the vital, still—healthy man you’ve always known recover and be able to return home?
Increasingly, the answer is yes. As many as 1.4 million seniors survive a stay in the ICU every year. And most go home, with varying degrees of disability.
ICUs are responding to older patients’ needs by helping them try to regain functioning — and by recruiting relatives in the effort.
“There’s a growing recognition that preparing patients and families for recovery needs to start in the ICU,” said Meghan Brooks Lane-Fall, an assistant professor of critical care at the Hospital of the University of Pennsylvania.
Making this transition more difficult is older patients’ vulnerability to a set of physical, cognitive and psychological problems known as post-ICU syndrome. This includes muscle weakness and other physical impairments; problems with thinking and memory; and symptoms of depression, anxiety and post-traumatic stress.
Researchers have been documenting the extent of difficulties that follow a stay in the ICU, fueled by post-ICU syndrome and patients’ underlying illnesses, in recent years. At the Yale School of Medicine, Lauren Ferrante studied 291 adults age 70 or older who were admitted to the ICU; she found that 52.3 percent regained their pre-ICU level of functioning. The remainder became more impaired or died. Generally, physical recovery occurred within six months of being discharged from the hospital.
Emotional recovery can take longer. In a recent analysis of 38 studies, researchers found that about a third of ICU patients, both young and old, developed depressive symptoms that persisted through 12 months of follow-up.
For doctors, the challenge is to distinguish between older patients who are likely to recover from an ICU stay and those who are not. This affects what families should be told, what interventions should be tried and what expectations for outcomes after the ICU should include.
For families, the challenge is to communicate an older patient’s wishes clearly and consistently to ICU physicians.
“Typically, doctors will be focused on technical concerns such as a patient’s hemoglobin or oxygen levels,” said Alison Turnbull, an assistant professor of critical care medicine at Johns Hopkins University. “Your job is, help them remember the big picture — the patient’s goals and values.”
Here are things you and your family can do to enhance the potential for a meaningful recovery:
- Be present. “Sit with your loved one,” Ferrante said. “Talk to them. Tell them what’s happening.” Doing so can help prevent delirium — an acute state of mental incoherence — and alleviate anxiety.
- Stay informed. Every day, be sure to ask, “What’s the plan for today?” And “try to have a sit-down meeting with a physician within the first day, and three to four days thereafter,” said Douglas White, director of the Program on Ethics and Decision Making in Critical Illness at the University of Pittsburgh. Among the questions that should guide these conversations, Turnbull suggested, is this: “Will this treatment help my loved one achieve her goals?”
- Emphasize recovery. “Once life-threatening problems have been resolved, start to ask doctors and nurses, ‘What can we do today to improve Mom’s function?’ ” White said.
- Helping ICU staff understand your loved one’s cues is “hugely important” and will help staff know when something isn’t working and how to respond, Lane-Fall noted.
- Minimize sedation. The use of sedatives such as benzodiazepines and narcotics can cause delirium and should be minimized to the extent possible in older patients, said Jason Katz, medical director of the cardiac intensive care unit and critical care service at the University of North Carolina School of Medicine and UNC Hospitals. If your loved one is heavily sedated, ask a physician if the medication can be safely cut back.
- Bring in essentials. Ferrante has found that unaddressed hearing and vision problems in the ICU can compromise recovery, most likely by contributing to disorientation and delirium. So, make sure your family member has eyeglasses and a hearing aid on hand.
- Mobilize early. Once someone is stabilized, make sure they’re getting out of bed and walking around, if they can. The sooner a physical therapist and occupational therapist start working with a patient to build strength and capacity, the better.
- Get them eating. It’s common for older adults to lose significant weight in the ICU — a health risk in itself. Keep an eye on what they’re being fed and, as soon as possible, ask if they can start eating on their own.
- Create an ICU diary. Having friends, family members, nurses and others write daily about what happened in the ICU can help patients deal with later anxiety related to not knowing what happened and feeling out of control.
- Prepare for home. More than half of seniors who survive a stay in the ICU are sent home without support from home health aides. So family members should get as much practical information as they can from nurses and therapists before leaving the ICU. It surely will come in handy later.