Can a 90 year old survive intubation?: Survival Rates and Quality of Life

According to a study published in the Journal of the American Geriatrics Society, 50% of patients aged 90 and older who undergo emergency intubation die in the hospital. This sobering statistic is central to understanding the complex question: Can a 90 year old survive intubation? Survival is possible, but it comes with a significantly lower probability compared to younger patients and substantial risks of long-term functional decline.

Quick Summary

Survival after emergency intubation for nonagenarians is possible, but data indicates high mortality and low discharge-to-home rates. Outcome is influenced by pre-existing conditions, frailty, and the reason for intubation. Patients often experience a dramatic functional decline, and quality of life is a major consideration for both patients and families.

Key Points

• High In-Hospital Mortality Rate: Studies show a 50% in-hospital mortality rate for patients aged 90 and older who undergo emergency intubation.

• Low Discharge-to-Home Rate: Only 14% of nonagenarian survivors of emergency intubation are discharged to their homes; most require transfer to nursing facilities.

• Pre-existing Conditions are Critical: A patient's underlying health status, including co-morbidities and frailty, heavily influences their survival and recovery prognosis.

• Significant Functional Decline is Common: Many elderly survivors of intubation and ICU care experience a permanent decline in function and independence, an outcome some may consider unacceptable.

• Quality of Life is a Major Consideration: Discussions about intubation for the very elderly must weigh potential long-term quality of life and the invasiveness of the procedure.

• Importance of Advance Directives: Having prior conversations and written advance directives is crucial in emergencies to ensure patient wishes are respected, given the high risks at an advanced age.

Survival Statistics for Emergency Intubation in Nonagenarians

Emergency intubation is a critical intervention, but its outcomes change significantly with advanced age.

In-Hospital Mortality Rates

Studies show that in-hospital mortality rates increase with age for older adults undergoing emergency intubation. For those aged 90 and older, the chance of surviving the hospital stay is about 50%, with the risk of death being significantly higher compared to those aged 65-74.

Discharge-to-Home Rates

Surviving intubation does not often mean returning directly home, especially for nonagenarians. Studies indicate low rates of discharge directly home for this age group, with many survivors requiring transfer to nursing facilities.

Factors Affecting Intubation Outcomes in the Elderly

Outcomes for a 90-year-old undergoing intubation are influenced by several factors, including the severity of their illness, existing chronic health conditions, level of frailty, and age-related physical changes that can impact the procedure.

Quality of Life After Intubation

A major concern for elderly patients and their families is the potential quality of life after intubation, as recovery can be challenging and lead to lasting health issues.

The ICU Stay and Recovery

An ICU stay for intubation can involve sedation, increasing the risk of delirium in elderly patients, which is linked to higher mortality and long-term cognitive problems. Recovery is often extensive, and many patients do not fully regain their previous functional abilities.

Long-Term Functional Decline

Older patients often experience a decline in function or mortality within a year of an ICU stay. Critical illness can cause muscle weakness, leading to dependence on others for daily tasks, an outcome some older adults find undesirable.

Decision-Making for Intubation in the Very Elderly

Decisions regarding intubation for nonagenarians should ideally incorporate the patient's wishes, often expressed through advance directives.

Shared Decision-Making vs. Emergency Action

While emergencies require quick decisions, data underscores the value of proactive discussions about these possibilities. Many older adults lack readily accessible advance directives in emergencies, yet studies suggest they often value quality of life over life extension at any cost. Surrogates may need to decide based on the patient's known values.

Non-Invasive Alternatives

Less invasive methods like BiPAP or high-flow nasal cannula can provide respiratory support, potentially offering time for improvement or informed decisions.

Comparison of Intubation Risks in Elderly vs. Younger Patients

Factor	Younger Patient (Under 65)	Elderly Patient (Over 65)	Nonagenarian Patient (90+)
In-Hospital Mortality	Significantly lower, varies by specific illness.	Higher; increases with age.	Roughly 50% in-hospital mortality.
Discharge-to-Home Rate	Higher percentage, depending on underlying illness.	Lower; only 24% for all 65+ survivors in one study.	Very low (14% in one study for emergency intubation).
Physical Reserve	High physiological reserve; better able to tolerate stress.	Reduced physiological reserve; less able to tolerate stress.	Minimal physiological reserve; highly vulnerable.
Risk of Functional Decline	Lower risk of severe, long-term functional decline.	Significant risk of functional decline or nursing home placement.	Very high risk of major functional decline or dependent care.
Cognitive Impact	Lower risk of long-term delirium or cognitive impairment.	Increased risk of delirium, which can lead to cognitive decline.	High risk of delirium and lasting cognitive changes.

Conclusion

While survival after intubation is possible for a 90-year-old, the likelihood is lower, with a 50% in-hospital mortality rate in emergency cases. Survivors often face a difficult recovery and significant functional decline, rarely returning to their previous independence. The high risk of long-term care placement and reduced quality of life highlights the need for early discussions about care goals and advance directives. Making informed decisions about this complex procedure involves considering more than just immediate survival statistics. For additional resources, {Link: the National Institute on Aging website https://www.nia.nih.gov/health/end-life-health-care-decisions/making-decisions-about-end-life-care} can provide information on end-of-life healthcare choices.

Frequently Asked Questions

What is the typical survival rate for a 90-year-old undergoing emergency intubation?

Studies show that patients aged 90 and older who undergo emergency intubation have approximately a 50% in-hospital mortality rate. While survival is possible, the chances are significantly lower than for younger patients.

If a 90-year-old survives intubation, are they likely to return home?

No, a return home is uncommon. Research indicates that only about 14% of nonagenarian survivors of emergency intubation are discharged directly to their homes, with the majority being transferred to a nursing or long-term care facility.

What are the common complications of intubation for a very elderly patient?

Complications can include a significant decline in cognitive function (delirium), pneumonia, muscle atrophy from prolonged immobilization, difficulty weaning from the ventilator, and overall a dramatic loss of independence.

Does the reason for intubation affect the outcome?

Yes, the underlying medical condition is a critical factor. Patients intubated for conditions like stroke or severe sepsis generally have worse outcomes than those with less severe issues, regardless of age.

Are there less invasive alternatives to intubation for elderly patients?

Yes, less invasive options such as BiPAP (bilevel positive airway pressure) or high-flow nasal cannula can sometimes be used to support breathing and may offer an alternative to intubation, especially in patients with a 'do not intubate' order.

Why are advance directives so important for very elderly patients?

Advance directives are important because in an emergency situation, the patient may not be able to communicate their wishes. Having a clear directive ensures that family members and medical staff understand the patient's preferences regarding life-sustaining treatments, which is especially critical given the high risks and potentially poor quality-of-life outcomes associated with intubation at an advanced age.

Can intubation cause lasting cognitive problems for an elderly person?

Yes, the process of intubation often involves sedation, which can trigger or worsen delirium in older patients. Delirium has been linked to long-term cognitive decline and can significantly impact recovery and future independence.