Lower income older adults at greater risk for health issues following intensive care stays, Yale study finds

In a study that could have implications for Connecticut as the state emerges from its latest COVID-19 surge, Yale researchers found that older adults with lower incomes were disproportionately likely to develop health issues following stays in the intensive care unit.

The effect was particularly strong when looking at cognitive health, with adults eligible for both Medicare and Medicaid — i.e. those who were both 65 and older and also low-income — more than 10 times more likely to develop probable dementia after an ICU stay than those not eligible for Medicaid.

“I hypothesized that we would find an association, but I was surprised by the magnitude of the association,” said Dr. Lauren Ferrante, an assistant professor of medicine at Yale and senior author of the new study. “I was really surprised to see the nearly 10-fold difference.”

Additionally, the study found, lower-income older adults were about 28% more likely to become physically disabled after an ICU stay than those with higher incomes.

The paper, which relied on data from the National Health and Aging Trends Study, examined patients nationwide who had been treated in the intensive care unit between 2011 and 2017.

Tekisha Everette, executive director of the Hartford-based Health Equity Solutions, said that study’s results make sense, given broader inequities in society.

“My initial response is that it doesn’t surprise me at all,” Everette said. “We know that income is a strong determinant of health, and we also know that if you have a lower income it probably has some correlation to your neighborhood and what supports and systems are available in your neighborhood.”

Ferrante has yet to study the causes of the gaps her team’s research revealed but said she suspects access to rehabilitation and other forms of post-acute care play a large role.

“Anybody can go to a hospital. If you show up to an emergency room you have to be treated,” Ferrante said. “But for post-acute care, there are many steps in the process relating to referral and access and someone doing the evaluation that might require going to your home. So it’s easy to see how structural differences in post-acute care might be contributing to someone’s ability to get the treatment they need to recover.”

Though the Yale research was conducted before the COVID-19 pandemic, its findings are particularly relevant at a time when hundreds of Connecticut residents have recently returned home from ICU stays related to coronavirus infection. This winter alone, Connecticut has seem thousands of people hospitalized with COVID-19, many of whom required intensive care.

In addition to the effects some patients may feel from long-haul COVID, which affects some portion of those who have the disease, lower-income patients are more likely to develop the types of health issues common to people leaving the ICU.

“This research highlights that among COVID and non-COVID patients who have been in the ICU, that they will be dealing with … a greater burden of disability or problems functioning when they get home and possibly a greater burden of cognitive difficulties that are separate from the actual effects of the COVID virus itself,” Ferrante said.

Ferrante said she hopes to explore disparities in post-ICU outcomes through further research. At some point, she said, she’ll be curious how the pandemic has affected this data.

“I think it would be very interesting to repeat the analysis among COVID patients who had been in the ICU,” Ferrante said. “I think it could potentially be even worse.”

Alex Putterman can be reached at aputterman@courant.com.