Impact of Age on Mortality in Critically Ill Adult Patients in Nepal- a Single Center Retrospective Study of 5 Years.

Overview

Rationale: Age is often considered a strong factor that determines the outcomes in critically ill patients. In a resource limited low middle income country (LMIC) like Nepal, the age factor is often considered when making treatment decisions by family especially when considering limiting treatment modalities. Whether or not this consideration of age for outcome prediction is appropriate however is a different discussion especially considering the fact that actual data from Nepalese ICUs are missing. Study Objective: To find the impact of age on mortality in critically ill patients. Design: A registry based, retrospective, descriptive study. Sample size: Convenience sampling of all the patients who are admitted to the ICU. Duration: Retrospective data from the 5-year period between November, 2019 to December, 2024. Place: Intensive care units (ICUs), Tribhuvan University Teaching Hospital (TUTH). Interventions: Not applicable Expected results: The study will help determine the mortality of the critically ill adult patients in terms of age.

Age is often considered a poor prognostic factor for most disease conditions. However the effect of age on mortality may not be as simple. Few studies have shown contradicting results such that chronological age exerted no effect on mortality. This may be due to the effect of physiological reserve and well being more than the chronological age. It has to be noted that with improvement in the overall health care along with the increase in the average life expectancy, ICUs all over the world will be facing a lot more of an "aged" population. This is even more relevant in our context. The average life expectancy at birth in Nepal has significantly gone up from about 65 years in 2000 AD to 70 years in 2021. This can be expected to improve further with improvements in neonatal and child mortality rates, immunization rates, the health care system delivery and reach. With this, the adult care medicine in Nepal should gear up to face older patients with a new set of challenges including increasing frailty, increasing comorbidities, increased requirements of supportive therapy including rehabilitation and nutrition. As of now age is often considered a significant factor for making health decisions in Nepal. In a resource limited setting in such an LMICs where a majority of the population lack health insurance coverage, health care costs are borne by the family. This, when added to the general notion that elderly patients have a poor prognosis, may lead to an unfounded decision to limit treatment decisions including withdrawal of treatments from the ICU. Rationale and Justification of study This study will help to determine the age related mortality of patients admitted to the ICU. As per the knowledge of the authors, no such large scale studies have been published from Nepal.