Academic Journal
Patterns of medical intermediate care unit use in critically ill very old patients in France.
| Τίτλος: | Patterns of medical intermediate care unit use in critically ill very old patients in France. |
|---|---|
| Συγγραφείς: | Migeon A; Department of Geriatrics, Tours University Hospital, Tours, France.; Clinical Data Center, Department of Public Health, Epidemiology Unit EpiDcliC, Tours University Hospital, Tours, France., Demiselle J; University of Strasbourg (UNISTRA), Department of Medicine, FHUTARGET, Medical Intensive Care Unit, Strasbourg University Hospital, Hautepierre Hospital, Strasbourg, France.; UMR 1260, INSERM (French National Institute of Health and Medical Research), Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France., Godillon L; Clinical Data Center, Department of Public Health, Epidemiology Unit EpiDcliC, Tours University Hospital, Tours, France., Leroy V; Department of Geriatrics, Tours University Hospital, Tours, France.; INSERM (French National Institute of Health and Medical Research), UMR 1253, iBrain, University of Tours, Tours, France., Grammatico-Guillon L; Clinical Data Center, Department of Public Health, Epidemiology Unit EpiDcliC, Tours University Hospital, Tours, France.; Research Unit MAVIVH, INSERM U1259, Medical School, University of Tours, Tours, France., Guillon A; Intensive Care Unit, Tours University Hospital, University of Tours, 2 Bd Tonnellé, 37044 Tours Cedex 9, Tours, France. antoine.guillon@univ-tours.fr.; INSERM (French National Institute of Health and Medical Research), UMR 1100, Research Center for Respiratory Diseases (CEPR), University of Tours, Tours, France. antoine.guillon@univ-tours.fr. |
| Πηγή: | European geriatric medicine [Eur Geriatr Med] 2026 Aug; Vol. 17 (4), pp. 1793-1802. Date of Electronic Publication: 2026 May 13. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer International Publishing Country of Publication: Switzerland NLM ID: 101533694 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1878-7649 (Print) Linking ISSN: 18787649 NLM ISO Abbreviation: Eur Geriatr Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2018- : Cham : Springer International Publishing Original Publication: Issy-les-Moulineaux, Paris : Elsevier Masson SAS |
| Ιατρικοί όροι (MeSH): | Critical Illness*/therapy , Critical Illness*/mortality , Intensive Care Units*/statistics & numerical data , Intermediate Care Facilities*/statistics & numerical data , Critical Care*/statistics & numerical data, France/epidemiology ; Length of Stay/statistics & numerical data ; Humans ; Female ; Aged, 80 and over ; Retrospective Studies ; Male ; Aged ; Middle Aged ; Adult ; Adolescent ; Young Adult ; Hospital Mortality |
| Περίληψη: | Purpose: The growing population of adults aged ≥ 80 represents major challenges for critical care. Intermediate care units (IMCUs) offer a level that could bridge the gap between ICU and standard ward, but information is lacking regarding IMCU use for older critically ill patients. This study aimed to characterize critical-care trajectories involving IMCU use among older critically ill patients at a national level. Methods: A nationwide retrospective cohort study was conducted in France, including all patients hospitalized in medical critical care in 2018. Patients were categorized as young (18-64), old (65-79), and very old adults (≥ 80). Trajectories between critical care units and general wards were visualized using Sankey diagrams. Overall survival was represented with Kaplan-Meier curves according to trajectory patterns. Results: Of 439,213 individuals admitted to medical critical care, 28.2% were aged ≥ 80. Among patients aged ≥ 80 admitted to an ICU, a step-up strategy (IMCU before ICU) was used in 12% of patients, and a step-down strategy (ICU followed by IMCU) in 23%. The step-up strategy was associated with high mortality in critical care (46.6%, compared to 33.9% for patients admitted directly to an ICU). Step-down patients had an extended critical care length of stay; however, those discharged from critical care via step-down strategy showed a lower cumulative mortality at one year (RR 0.86). Conclusion: IMCUs play a central role in the management of very old critically ill patients. The potential benefit of IMCU care for older adults transitioning out of the ICU should be evaluated in prospective clinical trials. (© 2026. The Author(s).) |
| Competing Interests: | DeclarationsCompliance with ethical standards. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval and consent to participate: No nominative, sensitive or personal data of patients have been collected. Our study involved the reuse of already recorded and anonymized data. The study falls within the scope of the French Reference Methodology MR-005 (declaration 2205437 v0, August 22nd, 2018, by the Teaching Hospital of Tours), which requires neither information nor consent of the included individuals. This study was consequently registered with the French Data Protection Board (CNIL MR-005 number I4116221019). |
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| Grant Information: | This study was supported by a grant from Inserm Inserm-MESSIDORE; the French Ministry of Health in the context of MESSIDORE call operated by IReSP (GENIALLY Inserm-MESSIDORE; 2022 Inserm-MESSIDORE; Inserm-MESSIDORE N° 72 Inserm-MESSIDORE |
| Contributed Indexing: | Keywords: Critical care; Intensive care unit; Intermediate care units; Long-term mortality; Old patients |
| Entry Date(s): | Date Created: 20260513 Date Completed: 20260911 Latest Revision: 20260913 |
| Update Code: | 20260913 |
| PubMed Central ID: | PMC13562155 |
| DOI: | 10.1007/s41999-026-01495-x |
| PMID: | 42129055 |
| Βάση Δεδομένων: | MEDLINE |
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