Academic journal article Best Practices in Mental Health

Criticial Care Recovery Center: Can a Geriatric Model of Care Guide Recovery of ICU Survivors?

Academic journal article Best Practices in Mental Health

Criticial Care Recovery Center: Can a Geriatric Model of Care Guide Recovery of ICU Survivors?

Article excerpt

Introduction

Post-intensive-care syndrome (PICS) is defined as cognitive, psychiatric, and/or physical decline after an intensive care unit (ICU) stay. The evidence suggests a strong connection between aging and PICS. More than 50 percent of ICU patients in developed countries are sixty-five or older, and older patients who have had critical illness are more likely to have poorer cognitive and functional outcomes than younger patients (Baldwin, 2015). Geriatric syndromes such as preexisting dementia and the new onset of delirium during ICU hospitalization are also associated with cognitive decline and higher rates of mortality during the post-hospitalization period (Cavallazzi, Saad, & Marik, 2012; Fong, Davis, Growdon, Albuquerque, & Inouye, 2015; Girard et al., 2010; Pandharipande et al., 2013). In a study of 821 patients who had respiratory failure or shock, 24 percent of younger adults had cognitive performance similar to patients with early Alzheimer's disease (Pandharipande et al., 2013). Finally, delirium in the ICU has been shown to cause a 6 times greater likelihood of dementia in adults sixty-five and older (Rockwood et al., 1999) and an 8.7 times greater likelihood in adults eighty-five and older (Davis et al., 2012). Despite the complex cognitive, psychiatric, and physical needs of patients with PICS, there are no established collaborative clinical care models for the management of the long-term effects of PICS. We argue that ICU survivors would benefit from a geriatric model of care because there is significant overlap between the diseases of aging (most notably dementia) and PICS.

Program Description

In 2010, Eskenazi Medical Center's pulmonary/critical care and geriatrics divisions developed the Critical Care Recovery Center (CCRC) to address the needs of ICU survivors. The CCRC is an innovative collaborative care model for ICU survivors, specifically designed to care for those who are at high risk of developing PICS. Criteria for admission to the CCRC include being eighteen years of age or older, having been admitted to Eskenazi Hospital's ICU, and either having spent forty-eight hours or longer on mechanical ventilation or having had delirium for forty-eight hours or longer.

The CCRC is modeled on the Healthy Aging Brain Center (HABC), an innovative model of dementia care developed by the geriatric medicine program at Wishard Health Services, now Eskenazi Medical Center (Boustani et al., 2011; Callahan et al., 2006). We chose a geriatric model of care for dementia as the model for the CCRC for several reasons. First, both dementia and PICS require collaborative care because of the complex cognitive, psychiatric, and functional needs of both populations of patients. Second, caregivers for critically ill patients can develop a syndrome known as PICS-family, which manifests psychiatric symptoms such as anxiety, posttraumatic stress disorder, depression, and complicated grief resulting from the traumatic experience of seeing a patient quite ill and having to care for that patient. In some aspects, PICS-family parallels the caregiver distress seen in caregivers of patients with dementia. The HABC recognizes the importance of caregivers in the well-being of patients and provides evaluation and services for caregivers. Third, given the well-established bidirectional relationship between delirium and dementia (Fong et al., 2015), we anticipated significant overlap between these populations. Fourth, the HABC model demonstrated rapid successful implementation of evidence-based practices for dementia patients and improvement in clinical outcomes such as lowered utilization of acute services (Boustani et al., 2011). By using the HABC as our model, we anticipated that the CCRC would also be able to rapidly implement evidence-based guidelines for delirium, such as the 2014 American Geriatrics Society Clinical Practice Guideline for Postoperative Delirium in Older Adults (American Geriatrics Society Expert Panel, 2015), as they were published. …

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