• Liron Sinvani, Andrzej Kozikowski, Vidhi Patel, Colm Mulvany, Dristi Talukder, Meredith Akerman, Renee Pekmezaris, Gisele Wolf-Klein, and Negin Hajizadeh.
• Liron Sinvani is a geriatrician-hospitalist, Division of Hospital Medicine, Andrzej Kozikowski, Vidhi Patel, and Renee Pekmezaris are research psychologists, Department of Medicine, Northwell Health, Manhasset, New York. Colm Mulvany and Dristi Talukder are research assistants, and Meredith Akerman is a biostatistician, Feinstein Institute for Medical Research, Manhasset, New York. Gisele Wolf-Klein is a geriatrician, Division of Hospital Medicine, Geriatric and Palliative Medicine, Northwell Health. Negin Hajizadeh is an intensivist, Pulmonary and Critical Care, Geriatric and Palliative Medicine, Northwell Health. ldanay@northwell.edu.
• Am. J. Crit. Care. 2018 Sep 1; 27 (5): 354-361.

BackgroundOlder adults account for more than half of all admissions to intensive care units; most remain alive at 1 year, but with long-term sequelae.ObjectiveTo explore geriatric-focused practices and associated outcomes in older intensive care survivors.MethodsIn a 1-year, retrospective, cohort study of patients admitted to the medical intensive care unit and subsequently transferred to the medicine service, adherence to geriatric-focused practices and associated clinical outcomes during intensive care were determined.ResultsA total of 179 patients (mean age, 80.5 years) met inclusion criteria. Nonadherence to geriatric-focused practices, including nothing by mouth (P = .004), exposure to benzodiazepines (P = .007), and use of restraints (P < .001), were associated with longer stay in the intensive care unit. Nothing by mouth (P = .002) and restraint use (P = .003) were significantly associated with longer hospital stays. Bladder catheters were associated with hospital-acquired pressure injuries (odds ratio, 8.9; 95% CI, 1.2-67.9) and discharge to rehabilitation (odds ratio, 8.9; 95% CI, 1.2-67.9). Nothing by mouth (odds ratio, 3.2; 95% CI, 1.2-8.0) and restraints (odds ratio, 2.8; 95% CI, 1.4-5.8) were also associated with an increase in 30-day readmission. Although 95% of the patients were assessed at least once by using the Confusion Assessment Method for the Intensive Care Unit (overall 2334 assessments documented), only 3.4% had an assessment that indicated delirium; 54.6% of these assessments were inaccurate.ConclusionAlthough initiatives have increased awareness of the challenges, implementation of geriatric-focused practices in intensive care is inconsistent.©2018 American Association of Critical-Care Nurses.

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