A new study says elderly patients requiring a ventilator while in the ICU and skilled nursing care after hospital discharge have a higher risk of returning to the hospital or dying within three years. Many elderly icu patients survive their critical illness and are well enough to leave the hospital, but that is not the end of their journey.

"A lot of these patients are at the highest risk of death and re-hospitalization and problems in the six months following discharge from the hospital." Dr. Hannah Wunsch from Columbia University and co-authors studied a random five percent sample of all medicare patients, 65 and older who received ICU treatment in 2003. Those patients were then followed for the next three years. "We found that the risk for patients who have been in the icu really was concentrated in a few select groups, including those who required mechanical ventilation and those who were discharged to skilled care facilities."

The study appears in this week's Journal of the American Medical Association. "We found up to a third of patients who received intensive care and were able to be discharged from the hospital needed to go to a skilled care facility and when we looked only at those patients who required mechanical ventilation, so the really sick patients, that number rose to two thirds of those patients." The study showed in 2003, more than 35 thousand patients received icu care and survived to hospital discharge.

"Overall this group does remain at an increased risk of death even three years later suggesting that there is an impact of being critically ill that we don't fully understand. That it's just not an acute process that there's a kind of chronic component that creeps in there."

Dr. Wunsch says the hope is to get patients home but that isn't always the outcome. "This is really the period of time when we need to be focusing on with these patients to ensure that they get the best possible care and that they're able to go on and move forward from their critical illness." Researchers say further study is needed to understand what kind of care these patients need and why they are not getting back to the same level of function they had before the hospitalization.