Table 1.
Characteristics of ICU hospitalizations contributed by older adults for each outcome by dual-eligible status.
| Characteristic* | Function | Cognition | Mental Health | |||
|---|---|---|---|---|---|---|
| Dual-eligible | Non-dual-eligible | Dual-eligible | Non-dual-eligible | Dual-eligible | Non-dual-eligible | |
| Sample n | 130 | 511 | 80 | 378 | 108 | 411 |
| Weighted n | 658,095 | 3,109,600 | 409,991 | 2,381,242 | 544,373 | 2,574,141 |
| Age, mean (SD), years | 80.9 (7.7) | 81.0 (7.1) | 79.2 (7.7) | 80.2 (7.1) | 80.7 (8.0) | 80.4 (7.0) |
| Age groups by years, no. (%) | ||||||
| 65–74 | 27 (20.8) | 102 (20.0) | 22 (27.5) | 87 (23.0) | 25 (23.1) | 91 (22.1) |
| 75–79 | 28 (21.5) | 115 (22.5) | 22 (27.5) | 91 (24.1) | 24 (22.2) | 97 (23.6) |
| 80–84 | 34 (26.2) | 126 (24.7) | 17 (21.2) | 89 (23.5) | 25 (23.2) | 98 (23.8) |
| 85–89 | 22 (16.9) | 101 (19.8) | 10 (12.5) | 70 (18.5) | 16 (14.8) | 81 (19.7) |
| ≥ 90 | 19 (14.6) | 67 (13.1) | 9 (11.2) | 41 (10.8) | 18 (16.7) | 44 (10.7) |
| Female, no. (%) | 85 (65.4) | 244 (47.7) | 54 (67.5) | 192 (50.8) | 74 (68.5) | 202 (49.2) |
| Race, no. (%) | ||||||
| Non-Hispanic White | 56 (43.1) | 401 (78.5) | 36 (45.0) | 300 (79.4) | 44 (40.7) | 326 (79.3) |
| Non-Hispanic Black | 49 (37.7) | 85 (16.6) | 31 (38.8) | 62 (16.4) | 42 (38.9) | 69 (16.8) |
| Hispanic | 16 (12.3) | 13 (2.5) | 8 (10.0) | 8 (2.1) | 15 (13.9) | 8 (2.0) |
| Others† | 9 (6.9) | 12 (2.4) | 5 (6.2) | 8 (2.1) | 7 (6.5) | 8 (2.0) |
| Education, no. (%) | ||||||
| Less than high school | 77 (59.2) | 108 (21.2) | 43 (53.8) | 73 (19.3) | 63 (58.3) | 81 (19.7) |
| Living Situation, no. (%) | ||||||
| Lives alone | 61 (46.9) | 171 (33.5) | 45 (56.2) | 123 (32.6) | 51 (47.2) | 135 (32.9) |
| Rural residence, no. (%) | 45 (34.6) | 129 (25.2) | 29 (36.2) | 96 (25.4) | 38 (35.2) | 102 (24.8) |
| Multimorbidity ≥ 3 chronic conditions‡, no. (%) | 98 (75.4) | 332 (65.0) | 60 (75.0) | 240 (63.5) | 80 (74.1) | 263 (64.0) |
| Frequency of self-reported chronic conditions, no. (%) | ||||||
| Diabetes | 55 (42.6) | 176 (34.5) | 32 (40.5) | 137 (36.2) | 41 (38.3) | 146 (35.5) |
| Hypertension | 108 (83.1) | 409 (80.0) | 69 (86.2) | 302 (79.9) | 92 (85.2) | 328 (79.8) |
| Stroke | 14 (10.8) | 35 (6.9) | 7 (8.8) | 21 (5.6) | 13 (12.0) | 24 (5.8) |
| Heart disease | 64 (50.0) | 191 (37.8) | 39 (48.8) | 143 (38.0) | 51 (47.2) | 152 (37.2) |
| Arthritis | 108 (83.1) | 356 (69.7) | 66 (82.5) | 261 (69.0) | 89 (82.4) | 284 (69.1) |
| Heart attack | 23 (17.7) | 55 (10.8) | 15 (18.8) | 39 (10.3) | 20 (18.5) | 41 (10.0) |
| Osteoporosis | 41 (31.5) | 134 (26.2) | 28 (35.0) | 97 (25.7) | 37 (34.3) | 111 (27.0) |
| Lung disease | 42 (32.8) | 137 (26.8) | 25 (31.6) | 104 (27.5) | 31 (29.0) | 111 (27.0) |
| Non-skin cancer | 19 (14.7) | 99 (19.4) | 13 (16.2) | 71 (18.8) | 16 (14.8) | 75 (18.3) |
| Primary Discharge Diagnosis for Index Admission | ||||||
| Infectious | 20 (15.4) | 76 (14.9) | 12 (15.0) | 50 (13.2) | 19 (17.6) | 57 (13.9) |
| Endocrine, metabolic, or electrolyte disorders | 6 (4.6) | 8 (1.6) | 4 (5.0) | 7 (1.8) | 5 (4.6) | 7 (1.7) |
| Neurologic | 15 (11.5) | 51 (10.0) | 9 (11.2) | 37 (9.8) | 12 (11.1) | 44 (10.7) |
| Cardiovascular | 43 (33.1) | 217 (42.5) | 28 (35.0) | 173 (45.8) | 37 (34.3) | 183 (44.5) |
| Respiratory | 14 (10.8) | 33 (6.5) | 7 (8.8) | 18 (4.8) | 8 (7.4) | 19 (4.6) |
| Gastrointestinal | 15 (11.5) | 52 (10.2) | 12 (15.0) | 44 (11.6) | 13 (12.0) | 47 (11.4) |
| Renal | 6 (4.6) | 8 (1.6) | 1 (1.2) | 6 (1.6) | 4 (3.7) | 6 (1.5) |
| Musculoskeletal | 6 (4.6) | 29 (5.7) | 3 (3.8) | 21 (5.6) | 6 (5.6) | 23 (5.6) |
| Hematologic/oncologic | 5 (3.8) | 37 (7.2) | 4 (5.0) | 22 (5.8) | 4 (3.7) | 25 (6.1) |
| Frailty (Range 0–5), Median (IQR)¶ | 3.0 (2.0,4.0) | 2.0 (1.0,3.0) | 2.0 (1.0,3.0) | 1.0 (0.0, 2.0) | 3.0 (2.0,4.0) | 1.0 (1.0,2.0) |
| Pre-ICU count of disabilities**(Range 0–6), Median (IQR) | 1.0 (0.0,3.0) | 0.0 (0.0,1.0) | 0.0 (0.0,1.0) | 0.0 (0.0,0.0) | 1.0 (0.0,3.0) | 0.0 (0.0,1.0) |
| Pre-ICU PHQ-4†† (Range 0–11), Median (IQR) | 4.0 (1.0,6.0) | 1.0 (0.0,3.0) | 3.0 (1.0, 6.0) | 1.0 (0.0,3.0) | 3.5 (1.0,6.0) | 1.0 (0.0,3.0) |
| Pre-ICU PHQ-2 (Range 0–6)‡‡, Median (IQR) | 2.0 (0.0,3.0) | 0.0 (0.0,2.0) | 2.0 (0.0,3.0) | 0.0 (0.0,2.0) | 2.0 (0.0,3.0) | 0.0 (0.0,2.0) |
| Pre-ICU GAD-2 (Range 0–6)§§, Median (IQR) | 2.0 (0.0,3.0) | 0.0 (0.0,1.0) | 1.0 (0.0,3.0) | 0.0 (0.0,1.0) | 2.0 (0.0,3.0) | 0.0 (0.0,1.0) |
| Pre-ICU Dementia Status, no. (%) | ||||||
| No Dementia | 70 (53.8) | 387 (75.7) | 58 (72.5) | 319 (84.4) | 57 (52.8) | 317 (77.1) |
| Possible Dementia | 23 (17.7) | 67 (13.1) | 22 (27.5) | 59 (15.6) | 22 (20.4) | 59 (14.4) |
| Probable Dementia | 37 (28.5) | 57 (11.2) | 0 (0) | 0 (0) | 29 (26.8) | 35 (8.5) |
| Time interval between pre-ICU NHATS interview and ICU hospitalization, Median (IQR), days | 195.0 (115.0, 301.0) | 170.0 (93.0, 270.0) | 220.5 (137.0, 316.0) | 189.0 (110.0, 279.0) | 212.0 (128.5, 316.0) | 189.0 (109.0, 279.0) |
| ICU Length of Stay§, Median (IQR), days | 2.0 (1.0, 4.0) | 2.0 (1.0, 4.0) | 2.0 (1.0, 3.0) | 2.0 (1.0, 4.0) | 2.0 (1.0, 3.0) | 2.0 (1.0, 4.0) |
| Hospital Length of Stay§, Median (IQR), days | 6.0 (3.0,10.0) | 6.0 (3.0,9.0) | 6.0 (3.0,10.0) | 5.0 (3.0,8.0) | 6.0 (3.0,10.0) | 5.0 (3.0,8.0) |
| Mechanical ventilation∥, no. (%) | 11 (8.5) | 48 (9.4) | 4 (5.0) | 32 (8.5) | 6 (5.6) | 35 (8.5) |
| Time interval between ICU hospitalization and post-ICU NHATS interview, Median (IQR), days | 171.50 (85.0, 252.0) | 191.0 (108.0, 269.0) | 133.5 (71.0, 208.5) | 174.0 (97.0, 257.0) | 146.5 (68.0, 229.0) | 174.0 (98.0, 255.0) |
Abbreviations: ICU = Intensive Care Unit, SD = Standard Deviation, CI = Confidence Interval, IQR = Interquartile Range, PHQ-4 = 4-item screening questionnaire for depression and anxiety or Patient Health Questionnaire-4, PHQ-2 = 2-item screening questionnaire for Depression or Patient Health Questionnaire-2, GAD-2 = 2-item screening questionnaire for Generalized Anxiety Disorder. Pre-ICU refers to values obtained from the NHATS assessment prior to ICU hospitalization.
The unit of observation is ICU hospitalization.
Values represent characteristics for the unweighted sample.
Includes American Indian, Alaska Native, Asian, Native Hawaiian, Pacific Islander, and other race as self-reported in the NHATS interview.
Multimorbidity was defined as ≥ 3 of 9 self-reported chronic conditions (diabetes mellitus, hypertension, stroke, heart disease, arthritis, heart attack, osteoporosis, lung disease, and non-skin cancer)
Ascertained from hospitalization record in linked Medicare claims data.
Ascertained from linked Medicare claims data using ICD-9 CM (96.7x) and ICD-10-PCS (5A1935Z,5A1945Z,5A1955Z) codes for mechanical ventilation
The frailty score is derived from the composite of 1 point for each of the five frailty criteria (range 0–5)– weight loss, muscle weakness, exhaustion, slow gait speed, and low physical activity.
Count of disabilities was characterized as the need for help or inability to perform four activities of daily living (eating, bathing, using the toilet, and dressing) and three mobility activities (getting outside, getting around inside one’s home, getting out of bed). Participants with maximal score of 7/7 in the pre-ICU interview were excluded, hence the range from 0–6.
PHQ-4 score was the sum of the responses to all four items in the screening for depression and anxiety questionnaire, the measure for our outcome of mental health. Response for each question ranged from 0–3; the total score ranged from 0–12. Participants with maximal score of 12/12 in the pre-ICU interview were excluded.
PHQ-2 score was the sum of the responses to two items in the screening for depression questionnaire. Response for each question ranged from 0–3; the total score ranged from 0–6.
GAD-2 score was the sum of the responses to two items in the screening for anxiety questionnaire. Response for each question ranged from 0–3; the total score ranged from 0–6.