Key result
Critically ill elderly patients show a ~13% annual decline in risk-adjusted mortality, outpacing younger cohorts.
Why the study?
Population aging and healthcare improvements may alter ICU care practices, but longitudinal data evaluating ICU admission trends and outcomes among critically ill elderly patients remain limited in China.
Cohort (n=31,535)
No
Absolute Event Rate: 12.5% vs 6.3%
p-value: p=<0.001
While ICU admission rates for elderly patients in China are declining, their risk-adjusted survival is improving more significantly over time compared to younger cohorts.
Declining elderly ICU admissions warrant caution in practice; leaves open whether trends reflect better prevention or shifted thresholds.
Background Population aging, coupled with improvements in healthcare, may influence ICU admission trends and care practices among critically ill elderly patients (≥80 years), longitudinal data evaluating this remain limited in China. Our aim was to analyze and compare trends in ICU admissions, clinical outcomes, and resource use among critically ill elderly patients (≥80 years), in comparison with older (65–79 years) and younger (16–64 years) cohorts. Methods We retrospectively analyzed ICU patients aged ≥16 years admitted to a tertiary referral hospital in China from January 2014 to December 2021. A total of 31,535 patients were categorized into three age groups: ≥ 80 years (11.5%), 65–79 years (30.7%), and <65 years (57.8%). Results ICU admission rates for elderly patients declined significantly from 13.2% in 2014 to 9.0% in 2021 (p < 0.001, relative decrease 31.8%), particularly among nonsurgical admissions. Elderly patients had higher comorbidities, greater disease severity scores, but lower daily average TISS-28 scores compared to younger cohorts. They were more likely to receive inotropic/vasopressor support and nutritional interventions, had higher blood loss due to frequent laboratory testing, and required more red blood cell transfusions. However, they were less likely to undergo invasive ventilation. The proportion of elderly patients requiring invasive ventilation decreased significantly over the study period. Despite a higher hospital mortality rate (elderly 14.1%, older 6.1%, younger 3.1%; p < 0.001), elderly patients demonstrated a more significant reduction in risk-adjusted mortality over time compared to younger patients (elderly vs. younger, 12.5% vs. 6.3%, relative reduction per year, p < 0.001). Conclusion ICU admission rates for elderly patients are declining, particularly in nonsurgical cases. Less invasive life support modalities have been increasingly utilized in their care. While mortality remains higher among elderly patients, they demonstrate a more significant improvement in survival over time compared to younger cohorts.
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Zhu et al. (2026) conducted a cohort in Critically ill patients (n=31,535). Elderly age (≥80 years) vs. Younger age (<65 years) and older age (65-79 years) was evaluated on Relative reduction in risk-adjusted mortality per year (p=<0.001). Critically ill elderly patients (≥80 years) demonstrated a more significant relative reduction in risk-adjusted mortality per year compared to younger patients (12.5% vs 6.3%, p<0.001).
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