Long term outcomes for elderly patients after emergency intensive care admission: A cohort study.

BACKGROUND: Elderly patients (≥ 80 years of age) surviving an episode of critical illness suffer long-term morbidity and risk of mortality. Identifying high risk groups could assist in informing discussions with patients and families. AIM: To determine factors associated with long-term survival following ICU admission. DESIGN: A cohort study of patients aged ≥ 80 years of age admitted to the ICU as an emergency. METHODS: Patients admitted from January 2010 to December 2018 were included in the study. Primary outcome was five year survival. Mortality was assessed using a multivariable flexible parametric survival analysis adjusted for demographics, and clinically relevant covariates. RESULTS: There were 828 patients. Mean age was 84 years (SD 3.2) and 419 (51%) were male. Patients were categorised into medical (423 (51%)) and surgical (405 (49%)) admissions. Adjusted hazard ratios (aHR) for mortality were highest for serum lactate (>8 mmol/l aHR 2.56 (C.I. 1.79-3.67)), lowest systolic blood pressure (< 70 mmHg aHR 2.04 (C.I. 1.36-3.05)) and pH (< 7.05 aHR 4.70 (C.I 2.67-8.21)). There were no survivors beyond one year with severe abnormalities of pH and lactate (< 7.05 and > 8 mmol/l respectively). Relative survival for medical patients was below that expected for the general population for the duration of the study. CONCLUSION: Overall five-year survival was 27%. For medical and surgical patients it was 19% and 35% respectively. Survival at 30 days and one year was 61% and 46%. The presence of features of circulatory shock predicted poor short and long term survival.

Ключевые меры политики для воздействия на социальные детерминанты здоровья и сокращения неравенства в отношении здоровья

Согласно имеющимся фактическим данным, вмешательства в четырех сферах – раннее развитие в детском возрасте, реализация права на труд и достойные условия труда, социальная защита и условия жизни – в состоянии оказывать максимальное воздействие на социальные детерминанты здоровья и неравенства в здоровье. В ходе систематического поиска и анализа рекомендаций и руководств в отношении политики, опубликованных межправительственными организациями и международными структурами, авторы сформулировали несколько реалистичных вариантов политики, на которых могут основываться конкретные меры по воздействию на социальные детерминанты в пределах вышеуказанных четырех тем. Варианты политики в первую очередь затрагивают такие вопросы, как образование и уход в раннем детском возрасте, детская бедность, стратегии инвестиций в условиях инклюзивной экономики, активные программы для рынка труда, условия труда, социальные выплаты наличными средствами, доступное жилье и механизмы планирования и регулирования для улучшения качества воздуха и смягчения последствий изменения климата. Авторы полагают, что применение различных комбинаций таких вариантов политики, наряду с эффективным руководством в поддержку справедливости в здоровье, позволит государствам-членам в Европейском регионе ВОЗ сократить неравенства в здоровье и синхронизировать усилия по достижению Целей в области устойчивого развития ООН. Эта публикация была представлена для обсуждения в качестве справочного документа на Шестьдесят седьмой сессии Европейского регионального комитета, Будапешт, 11–14 сентября 2017 г.

Key policies for addressing the social determinants of health and health inequities

Evidence indicates that actions within four main themes (early child development, fair employment and decent work, social protection, and the living environment) are likely to have the greatest impact on the social determinants of health and health inequities. A systematic search and analysis of recommendations and policy guidelines from intergovernmental organizations and international bodies identified practical policy options for action on social determinants within these four themes. Policy options focused on early childhood education and care; child poverty; investment strategies for an inclusive economy; active labour market programmes; working conditions; social cash transfers; affordable housing; and planning and regulatory mechanisms to improve air quality and mitigate climate change. Applying combinations of these policy options alongside effective governance for health equity should enable WHO European Region Member States to reduce health inequities and synergize efforts to achieve the United Nations Sustainable Development Goals. This publication was tabled as a background document during the Sixty-seventh session of the Regional Committee for Europe, Budapest, 11–14 September 2017.

Key policies for addressing the social determinants of health and health inequities

Evidence indicates that actions within four main themes (early child development, fair employment and decent work, social protection, and the living environment) are likely to have the greatest impact on the social determinants of health and health inequities. A systematic search and analysis of recommendations and policy guidelines from intergovernmental organizations and international bodies identified practical policy options for action on social determinants within these four themes. Policy options focused on early childhood education and care; child poverty; investment strategies for an inclusive economy; active labour market programmes; working conditions; social cash transfers; affordable housing; and planning and regulatory mechanisms to improve air quality and mitigate climate change. Applying combinations of these policy options alongside effective governance for health equity should enable WHO European Region Member States to reduce health inequities and synergize efforts to achieve the United Nations Sustainable Development Goals.