Assessment of socio-economic implications on family and health related quality of life among intensive care unit survivors of a combat tertiary care hospital in India: A 6 month follow-up study

With advances in medical technology, the care provided by intensive care units has improved a lot. This is reflected as increase in survival rate of ICU patients. Despite reduction in mortality, a significant number of ICU survivors suffer from cognitive, physical and mental impairments. These impairments are also labelled as post-intensive care syndrome. Though there is very scarce epidemiological data it is estimated that 50% or more of ICU survivors suffer from one or more of its components.

These impairments are associated with reduced health related quality of life of survivors and have impact on resuming independent living and employment. Further they may be socio-economic consequences on the patients as well as their immediate families. Covinsky et al followed patients for a year who were discharged after hospitalization with some serious illness. They observed that 34% of the patients required considerable care giving assistance. In 20% of the cases. a family member had to leave work and a third of families reported a loss of major source of income. Loss of employment of one or other family members along with consequential requirement for care may jeopardize the family social and economic stability. There are reports of family members experiencing stress and negative health outcomes themselves.

As combat hospitals provide free of cost medical services to the entitled patients, it is assumed that it does not impose any financial burden on the serving personnels or exservicemen and their families. However the socio-economic impact of critical illnesses on survivors and their families on ground is largely un-determined. Majority of the serving combat personnels are posted in far-lying areas and are staying away from the family which usually includes dependent elderly parents, spouse and children. They may have non-dependent brothers, sisters or some other relatives who are looking after their families in their absence. It happens a number of times that despite some serious medical condition of a family member, they are not able to visit them or visit them for only a brief period of time due to service contingencies/ organisation requirements. Further the dependents may not be able to avail medical services for follow-up in service hospitals which may be due to many factors like service hospitals are at considerable distance from their residence, non-availability of transport or some accompanying personnel. Many times, some family members lose employment or have to leave the job to look after the survivor or there is need to hire some care-giver. These factors in combination may have profound socio-economic implications on family and health related quality of life of survivors. To date, there have been limited attempts to estimate the magnitude of this issue.

The present cohort study aims at assessing the socio-economic implications on family using a novel question set designed to assess the changes and health related quality of life using a Short Form-12 self-report questionnaire among intensive care unit survivors of a combat tertiary care hospital in India.