Successfully Treating Elderly Patients in the ICU

Safety is in the details

Successfully Treating Elderly Patients in the ICU

April 13, 2017

As the Baby Boomer generation gets older, hospitals are seeing a big increase in elderly patients. In critical care units, such as the ICU, there has always been a higher percentage of elderly patients compared to other hospital departments, but even those numbers are increasing.

In fact, around two-thirds of ICU beds are occupied by patients who are 65 years or older. As a result, meeting the needs of elderly patients is a top concern for nurses in the ICU. This blog is a short review of the major needs of elderly patients in the ICU.

The Importance of Geriatric Experience

The growing population of elderly adults in the ICU challenges hospitals to adapt their care services. Hospitals are focusing more effort on building teams of care providers who have experience with elderly patients. Ideally, these teams include nurses, a geriatrician, an intensivist, and a physical therapist, among other specialized care providers as required.

Preventing and Treating Sepsis

Sepsis is one of the top five most common admitting diagnoses for elderly patients in the ICU. Among elderly patients who survive sepsis, research has shown that 76% were less likely to return home after being discharged from the hospital – requiring additional care from skilled nursing homes and similar facilities.

Nurses can lower mortality rates among elderly patients with sepsis by identifying and managing sepsis in the early stages of the patient’s stay in the ICU. Methods for identifying sepsis include screening for sources of infection, identifying chronic conditions, screening for functional decline, and monitoring subtle changes in mental status.

Overcoming Delirium

Many patients experience delirium in the ICU, and unfortunately, elderly patients are at a high risk of delirium. In a study of older adults admitted to medical ICUs, researchers found that 62% of patients had evidence of delirium during their stay. Others studies have found rates as high as 70% to 80%.

Traditional mental status evaluation methods, such as the Glasgow Coma Scale and Ramsay Scale are effective for measuring wakefulness and arousal, but they do not provide insight into the patient’s state of mind. On the other hand, the confusion assessment method for the ICU (CAM-ICU) has proven effective and reliable for assessing a patient’s mental state.

Delirium is difficult to track in the ICU because patients are often sedated and intubated, and we currently lack the proper tools to monitor delirium without communicating with the patient. However, the recognition of delirium is important because it typically prolongs the patient’s hospital stay, increases short-term mortality, and raises costs in the ICU.

Preventing Disconnections and Misconnections
Since elderly ICU patients are prone to delirium, they sometimes forget they are in the hospital and have an adverse reaction to all of the sounds surrounding them and the tubes connected to them. As a result, the patient may accidentally (or intentionally) disconnect their IVs by pulling the tubes apart or attempting to get out of bed.

To avoid such instances, the Safe2 Rotator has a unique spinning lock that helps prevent tubing disconnections and consequential misconnection.

In order for elderly patients to get the care they need and to recover smoothly, they need consistent delivering of medication. The Safe2 Rotator and the Marvelous™ stopcock that uses a luer activated design and a circumferential inner channel also result in improved infection control and reduction of medication errors.

Keeping Elderly ICU Patients Safe

As more and more elderly patients require treatment in the ICU, it becomes more important to raise awareness to the special concerns of treating these patients. With such awareness, both patient safety and staff safety can be enhanced.

Safety is in the details