Research to Improve ICU Outcomes Among Older Adults

The mission of the Research to Improve ICU Outcomes Among Older Adults (RECOVER) Program is to improve the care and outcomes of older adults in the intensive care unit (ICU). The program is led by Lauren Ferrante, MD, MHS, a pulmonary and critical care physician with expertise in aging research, who also serves as a core director in the Yale Claude D. Pepper Older Americans Independence Center. Work conducted in the program bridges critical care medicine and geriatrics to improve our understanding of patient-centered outcomes and develop interventions for older adults in the ICU or who have survived critical illness. Through epidemiologic analysis of large datasets, enrollment of new observational patient cohorts, and interventional studies, research conducted in the program aims to improve the outcomes of older adults across the spectrum of critical illness and recovery.

Adults aged 65 and older make up more than half of all ICU bed-days, a trend that is expected to continue with the aging of the U.S. population. To provide personalized care in the ICU, it is important to consider the unique factors that may impact older adults, such as pre-existing frailty, hearing loss, or cognitive impairment. Moreover, research has shown that older adults most value health outcomes such as maintaining functional independence and quality of life. The goal of the RECOVER program is to unite these personalized considerations and health priorities through science to achieve the outcomes that matter most to older adults in the ICU.

Geriatric models of care, such as Acute Care for Elders (ACE) units, have been shown to improve outcomes in hospitalized older adults outside the ICU. We identified components from these models that are not routinely implemented in ICUs and developed a geriatrics bundle comprising three interventions: treatment of hearing impairment, deprescribing of potentially inappropriate medications (PIMs), and default provision of occupational therapy (OT). In a pilot clinical trial, this bundled intervention reduced incident delirium in older adults.

Our team has extensive experience using nationally representative cohort studies, such as the National Health and Aging Trends Study (NHATS), linked to Medicare data to conduct longitudinal analyses evaluating health outcomes among older ICU survivors. In these projects, we are particularly interested in the outcomes of vulnerable older adults, such as those with age-related vulnerability (frailty, cognitive impairment), social vulnerability (social isolation), and socioeconomic disadvantage or health-related social needs.