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Objectives: Older adults who survive critical illness are at risk for increased disability, limiting their independence and quality of life. We sought to evaluate whether the occurrence of symptoms that restrict activity, that is, restricting symptoms, is associated with increased disability following an ICU hospitalization., Design: Prospective longitudinal study of community-living adults 70 years old or older who were interviewed monthly between 1998 and 2018., Setting: South Central Connecticut, United States., Patients: Two hundred fifty-one ICU admissions from 202 participants who were discharged alive from the hospital., Interventions: None., Measurements and Main Results: Occurrence of 15 restricting symptoms (operationalized as number of symptoms and presence of ≥ 2 symptoms) and disability in activities of daily living, instrumental activities of daily living, and mobility was ascertained during monthly interviews throughout the study period. We constructed multivariable Poisson regression models to evaluate the association between post-ICU restricting symptoms and subsequent disability over the 6 months following ICU hospitalization, adjusting for known risk factors for post-ICU disability including pre-ICU disability, frailty, cognitive impairment, mechanical ventilation, and ICU length of stay. The mean age of participants was 83.5 years ( sd , 5.6 yr); 57% were female. Over the 6 months following ICU hospitalization, each unit increase in the number of restricting symptoms was associated with a 5% increase in the number of disabilities (adjusted rate ratio, 1.05; 95% CI, 1.04-1.06). The presence of greater than or equal to 2 restricting symptoms was associated with a 29% greater number of disabilities over the 6 months following ICU hospitalization as compared with less than 2 symptoms (adjusted rate ratio, 1.29; 95% CI, 1.22-1.36)., Conclusions: In this longitudinal cohort of community-living older adults, symptoms restricting activity were independently associated with increased disability after ICU hospitalization. These findings suggest that management of restricting symptoms may enhance functional recovery among older ICU survivors., Competing Interests: Drs. Jain, Ferrante, and Gill received support from the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342). Dr. Jain was supported by the Parker B. Francis Family Foundation Fellowship Award, the Yale Physician-Scientist Development Award, the National Institute on Aging (NIA), and the National Institutes of Health (NIH) under Award Number R03AG078942. During the course of this work, Dr. Ferrante was supported by a Paul B. Beeson Emerging Leaders in Aging Career Development Award (K76 AG057023). Dr. Feder was supported by National Heart, Lung, and Blood Institute K12HL138037. Drs. Han, Leo-Summers, Ferrante, and Gill received support for article research from the NIH. Drs. Leo-Summers’s and Gill’s institution received funding from the NIH. Dr. Ferrante’s institution received funding from the NIA. Dr. Gahbauer has disclosed that she does not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Objectives: Factors common to socioeconomically disadvantaged neighborhoods, such as low availability of transportation, may limit access to restorative care services for critical illness survivors. Our primary objective was to evaluate whether neighborhood socioeconomic disadvantage was associated with an increased disability burden after critical illness. Our secondary objective was to determine if the effect differed for those discharged to the community compared with those discharged to a facility., Design: Longitudinal cohort study with linked Medicare claims data., Setting: United States., Patients: One hundred ninety-nine older adults, contributing to 239 ICU admissions, who underwent monthly assessments of disability for 12 months following hospital discharge in 13 different functional tasks from 1998 to 2017., Measurements and Main Results: Neighborhood disadvantage was assessed using the area deprivation index, a 1-100 ranking evaluating poverty, housing, and employment metrics. Those living in disadvantaged neighborhoods (top quartile of scores) were less likely to self-identify as non-Hispanic White compared with those in more advantaged neighborhoods. In adjusted models, older adults living in disadvantaged neighborhoods had a 9% higher disability burden over the 12 months following ICU discharge compared with those in more advantaged areas (rate ratio, 1.09; 95% Bayesian credible interval, 1.02-1.16). In the secondary analysis adjusting for discharge destination, neighborhood disadvantage was associated with a 14% increase in disability burden over 12 months of follow-up (rate ratio, 1.14; 95% credible interval, 1.07-1.21). Disability burden was 10% higher for those living in disadvantaged neighborhoods and discharged home as compared with those discharged to a facility, but this difference was not statistically significant (interaction rate ratio, 1.10; 95% credible interval, 0.98-1.25)., Conclusions: Neighborhood socioeconomic disadvantage is associated with a higher disability burden in the 12 months after a critical illness. Future studies should evaluate barriers to functional recovery for ICU survivors living in disadvantaged neighborhoods., Competing Interests: Dr. Falvey received grant support from a Foundation for Physical Therapy Research Pipeline to Health Services Research Grant, a National Institute on Aging (NIA) training grant T32AG019134, and from the University of Maryland Claude D. Pepper Older Americans Independence Center (P30AG028747). Dr. Murphy is supported by the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Dr. Ferrante is supported by a Paul B. Beeson Emerging Leaders Career Development Award in Aging from the NIA (K76AG057023) and the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. Dr. Falvey’s institution received support for article research from the Foundation for Physical Therapy Research. Drs. Falvey’s, Murphy’s, Gill’s, and Ferrante’s institutions received funding from the National Institutes on Aging (NIA). Drs. Falvey, Murphy, Gill, and Ferrante received support for article research from the National Institutes of Health. Dr. Leo-Summers received support for article research from the NIA., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Background: Older adults admitted to an intensive care unit (ICU) are at risk for developing impairments in function, cognition, and mental health. It is not known whether socioeconomically disadvantaged older persons are at greater risk for these impairments than their less vulnerable counterparts., Objective: To evaluate the association between socioeconomic disadvantage and decline in function, cognition, and mental health among older survivors of an ICU hospitalization., Design: Retrospective analysis of a longitudinal cohort study., Setting: Community-dwelling older adults in the National Health and Aging Trends Study (NHATS)., Participants: Participants with ICU hospitalizations between 2011 and 2017., Measurements: Socioeconomic disadvantage was assessed as dual-eligible Medicare-Medicaid status. The outcome of function was defined as the count of disabilities in 7 activities of daily living and mobility tasks, the cognitive outcome as the transition from no or possible to probable dementia, and the mental health outcome as the Patient Health Questionnaire-4 score in the NHATS interview after ICU hospitalization. The analytic sample included 641 ICU hospitalizations for function, 458 for cognition, and 519 for mental health., Results: After accounting for sociodemographic and clinical characteristics, dual eligibility was associated with a 28% increase in disability after ICU hospitalization (incidence rate ratio, 1.28; 95% CI, 1.00 to 1.64); and nearly 10-fold greater odds of transitioning to probable dementia (odds ratio, 9.79; 95% CI, 3.46 to 27.65). Dual eligibility was not associated with symptoms of depression and anxiety after ICU hospitalization (incidence rate ratio, 1.33; 95% CI, 0.99 to 1.79)., Limitation: Administrative data, variability in timing of baseline and outcome assessments, proxy selection., Conclusion: Dual-eligible older persons are at greater risk for decline in function and cognition after an ICU hospitalization than their more advantaged counterparts. 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., Primary Funding Source: National Institute on Aging.

Importance: Disability and mortality are common among older adults with critical illness. Older adults who are socially isolated may be more vulnerable to adverse outcomes for various reasons, including fewer supports to access services needed for optimal recovery; however, whether social isolation is associated with post-intensive care unit (ICU) disability and mortality is not known., Objectives: To evaluate whether social isolation is associated with disability and with 1-year mortality after critical illness., Design, Setting, and Participants: This observational cohort study included community-dwelling older adults who participated in the National Health and Aging Trends Study (NHATS) from May 2011 through November 2018. Hospitalization data were collected through 2017 and interview data through 2018. Data analysis was conducted from February 2020 through February 2021. The mortality sample included 997 ICU admissions of 1 day or longer, which represented 5 705 675 survey-weighted ICU hospitalizations. Of these, 648 ICU stays, representing 3 821 611 ICU hospitalizations, were eligible for the primary outcome of post-ICU disability., Exposures: Social isolation from the NHATS survey response in the year most closely preceding ICU admission, which was assessed using a validated measure of social connectedness with partners, families, and friends as well as participation in valued life activities (range 0-6; higher scores indicate more isolation)., Main Outcomes and Measures: The primary outcome was the count of disability assessed during the first interview following hospital discharge. The secondary outcome was time to death within 1 year of hospital admission., Results: A total of 997 participants were in the mortality cohort (511 women [51%]; 45 Hispanic [5%], 682 non-Hispanic White [69%], and 228 non-Hispanic Black individuals [23%]) and 648 in the disability cohort (331 women [51%]; 29 Hispanic [5%], 457 non-Hispanic White [71%], and 134 non-Hispanic Black individuals [21%]). The median (interquartile range [IQR]) age was 81 (75.5-86.0) years (range, 66-102 years), the median (IQR) preadmission disability count was 0 (0-1), and the median (IQR) social isolation score was 3 (2-4). After adjustment for demographic characteristics and illness severity, each 1-point increase in the social isolation score (from 0-6) was associated with a 7% greater disability count (adjusted rate ratio, 1.07; 95% CI, 1.01-1.15) and a 14% increase in 1-year mortality risk (adjusted hazard ratio, 1.14; 95% CI, 1.03-1.25)., Conclusions and Relevance: In this cohort study, social isolation before an ICU hospitalization was associated with greater disability burden and higher mortality in the year following critical illness. The study findings suggest a need to develop social isolation screening and intervention frameworks for older adults with critical illness.

Objectives: Intervening illnesses and injuries have pronounced deleterious effects on functional status in older persons, but have not been carefully evaluated after critical illness. We set out to evaluate the functional effects of intervening illnesses and injuries in the year after critical illness., Design: Prospective longitudinal study of 754 nondisabled community-living persons, 70 years old or older., Setting: Greater New Haven, CT, from March 1998 to December 2018., Patients: The analytic sample included 250 ICU admissions from 209 community-living participants who were discharged from the hospital., Interventions: None., Measurements and Main Results: Functional status (13 activities) and exposure to intervening illnesses and injuries leading to hospitalization, emergency department visit, or restricted activity were assessed each month. Comprehensive assessments (for covariates) were completed every 18 months. In the year after critical illness, recovery of premorbid function was observed for 169 of the ICU admissions (67.6%), and the mean (sd) number of episodes of functional decline (from 1 mo to the next) was 2.2 (1.6). The adjusted hazard ratios (95% CI) for recovery were 0.18 (0.09-0.39), 0.46 (0.17-1.26), and 0.75 (0.48-1.18) for intervening hospitalizations, emergency department visits, and restricted activity, respectively. For functional decline, the corresponding odds ratios (95% CI) were 2.06 (1.56-2.73), 1.78 (1.12-2.83), and 1.25 (0.92-1.69). The effect sizes for hospitalization and emergency department visit were larger than those for any of the covariates., Conclusions: In the year after critical illness, intervening illnesses and injuries leading to hospitalization and emergency department visit are strongly associated with adverse functional outcomes, with effect sizes larger than those of traditional risk factors. To improve functional outcomes, more aggressive efforts will be needed to prevent and manage intervening illnesses and injuries after critical illness., Competing Interests: Dr. Gill is supported by the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Dr. Ferrante is supported by a Paul B. Beeson Emerging Leaders in Aging Research Career Development Award from the National Institute on Aging (NIA) (K76AG057023). Drs. Gill’s, Murphy’s, and Ferrante’s institution received funding from the National Institutes of Health (NIH)/NIA. Drs. Gill, Han, Leo-Summers, Murphy, and Ferrante received support for article research from the NIH. Dr. Han’s institution received funding from NIA R01AG017560 and Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Dr. Gahbauer disclosed that he does not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Objectives: To evaluate the association between the type of acute hospitalization and subsequent course of disability in older persons discharged to a skilled nursing facility (SNF)., Design: Longitudinal study of 754 community-living persons aged 70 or older., Participants: The analytical sample included 365 participants who had one or more admissions to a SNF after an acute hospitalization (n=520 index admissions)., Measurements: Information on hospitalizations, SNF admissions, and disability was ascertained over 15years. The primary and secondary outcomes were disability burden and recovery of pre-hospital function, respectively, assessed monthly over a 6-month period. Index admissions were classified into four mutually exclusive groups based on the type of hospitalization: elective major surgery, non-elective major surgery, critical illness, and other., Results: Disability worsened considerably after hospitalization for each of the four groups. Relative to elective major surgery, the disability burden over 6months was significantly greater for non-elective major surgery, critical illness, and other hospitalizations, with adjusted rate ratios (RRs) of 1.37 (95% CI 1.19 to 1.59), 1.37 (95% CI 1.19 to 1.58), and 1.29 (95% CI 1.14 to 1.47), respectively. Overall, recovery to pre-hospital function was observed in only 132 (25.4%) admissions. Relative to elective major surgery, the likelihood of recovering pre-hospital function was considerably lower for each of the three other groups. The results were consistent for basic, instrumental and mobility activities., Conclusion: Among older persons discharged to a SNF after an acute hospitalization, the functional course over 6months was generally poor, with recovery to pre-hospital function observed in only one out of every four cases. Relative to elective major surgery, functional outcomes were worse for non-elective major surgery, critical illness, and other hospitalizations., (Copyright © 2017 Elsevier Inc. All rights reserved.)