Deficits in Self-Reported Initiation Are AssociatedWith Subsequent Disability in ICU Survivors

• Main Authors: Brummel, N.E (Author), Chandrasekhar, R. (Author), Dittus, R.S (Author), Duggan, M.C (Author), Ely, E.W (Author), Jackson, J.C (Author), Patel, M.B (Author), Wilson, J.E (Author)
• Format: Article
• Language: English
• Published: Elsevier Inc. 2019
• Subjects: Activities of Daily Living; activity of daily living assessment; ADL disability; adult; aged; Aged; Article; behavior rating inventory of executive function; cognition; cognitive defect; cohort analysis; Cohort Studies; comorbidity; critical illness; Critical Illness; daily life activity; disabled person; Disabled Persons; executive function; Executive Function; female; Female; function; functional activities questionnaire; human; Humans; intensive care unit; Intensive Care Units; logistic regression analysis; major clinical study; male; Male; middle aged; Middle Aged; observational study; Prospective Studies; prospective study; psychology; questionnaire; self report; Self Report; survivor; Survivors
• Online Access: View Fulltext in Publisher

 Objective: To determine whether deficits in a key aspect of executive functioning, namely, initiation, were associated with current and future functional disabilities in intensive care unit survivors. Methods: A nested substudy within a 2-center prospective observational cohort. We used 3 tests of initiation at 3 and 12 months: the Ruff Total Unique Design, Controlled Oral Word Association, and Behavior Rating Inventory of Executive Function initiation. Disability in instrumental activities of daily living (IADL) was measured with the Functional Activities Questionnaire. We used a proportional odds logistic regression model to evaluate the association between initiation and disability. Covariates in the model included age, education, baseline Functional Activities Questionnaire, pre-existing cognitive impairment, comorbidities, admission severity of illness, episodes of hypoxia, and days of severe sepsis. Results: In 195 patients, after adjusting for covariates, only the Behavior Rating Inventory of Executive Function initiation was associated with disability at any time point. Comparing the 25th vs the 75th percentile scores (95% confidence interval) of the Behavior Rating Inventory of Executive Function initiation at 3 months, patients with worse initiation scores had 5.062 times the odds (95% confidence interval: 2.539, 10.092) of disability according to the Functional Activities Questionnaire at 3 months, with similar odds at 12 months (odds ratio: 3.476, 95% confidence interval: 1.943, 6.216). Worse Behavior Rating Inventory of Executive Function initiation scores at 3 months were associated with future disability at 12 months odds ratio (95% confidence interval) 5.079 (2.579, 10.000). Conclusions: Executive function deficits acquired after a critical illness in the domain of initiation are common in intensive care unit survivors, and when they are identified via self-report tools, they are associated with current and future disability in instrumental activities of daily living. © 2018 Academy of Consultation-Liaison Psychiatry