Aging Pearls: Pulmonary/Critical Care Medicine Answer Guide

Carol L. Howe, MD, MLS, College of Medicine, University of Arizona

  1. Although usually contraindicated in older adults, benzodiazepines are often required in intensive care unit settings to treat ICU associated delirium, and, when used prophylactically, have been shown to decrease the incidence of delirium among older adults in these settings. True or False?

False. Exposure to benzodiazepines, including lorazepam and midazolam, is one of the most modifiable risk factors for the development of delirium in the ICU. [1]

  1. Elderly patients (≥70 yrs) with non-small cell lung cancer(NSLC) do not have worse outcomes after pulmonary resection than their younger counterparts. True or False?

True. A 2011multi-institutional French study of 1,969 patients ≥70 years old with NSLC stage I or Stage II matched with 1, 969 control patients < 70 years old matched for sex, American Society of Anesthesia score, performance status, and FEV1, concluded the following:

Elderly patients with NSCLC should not be denied pulmonary resection on the basis of chronologic age alone. Among patients aged ≥ 70 years, 90-day mortality compared acceptably with mortality among younger matched patients. Additionally, the data show that for older patients, a 90-day mortality better represents their real mortality risk than 30- or 60-day figures. Our contemporary, multiinstitutional data importantly reveal that elderly patients, compared with their younger counterparts, do not have increased morbidity, incidence, or severity after pulmonary resection.[2](abstract)

  1. Older patients with ICU stays who survive do not, in general, have any subsequent adverse cognitive outcomes. True or False?

False.In a large study of Medicare beneficiaries who had been in intensive care, survived, and were followed up three years later, the following diagnoses were independently associated with a subsequent diagnosis of dementia at follow-up: severe infection or sepsis, neurologic dysfunction, and acute dialysis.[3]

[1]Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors fordelirium across hospital settings.Best Pract Res ClinAnaesthesiol. 2012;26(3):277-87. PubMed PMID: 23040281.

[2]Rivera C, Falcoz PE, Bernard A, Thomas PA, Dahan M. Surgical management andoutcomes of elderly patients with early stage non-small cell lung cancer: anested case-control study. Chest. 2011;140(4):874-80. 24. PubMed PMID: 21436251.

[3]Guerra C, Linde-Zwirble WT, Wunsch H. Risk factors for dementia after critical illness in elderly Medicare beneficiaries. Crit Care. 2012;16(6):R233.PubMed PMID: 23245397.