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The trajectory of very old critically ill patients

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Abstract

The demographic shift, together with financial constraint, justify a re-evaluation of the trajectory of care of very old critically ill patients (VIP), defined as older than 80 years. We must avoid over- as well as under-utilisation of critical care interventions in this patient group and ensure the inclusion of health care professionals, the patient and their caregivers in the decision process. This new integrative approach mobilises expertise at each step of the process beginning prior to intensive care unit (ICU) admission and extending to long-term follow-up. In this review, several international experts have contributed to provide recommendations that can be universally applied. Our aim is to define a minimum core dataset of information to be shared and discussed prior to ICU admission and to facilitate the shared-decision-making process with the patient and their caregivers, throughout the patient journey. Documentation of uncertainty may contribute to a tailored level of care and ultimately to discussions around possible limitations of life sustaining treatments. The goal of ICU care is not only to avoid death, but more importantly to maintain an acceptable quality of life and functional autonomy after hospital discharge. Societal consideration is important to highlight, together with alternatives to ICU admission. We discuss challenges for the future and potential areas of research. In summary, this review provides a state-of-the-art current overview and aims to outline future directions to address the challenges in the treatment of VIP.

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Authors and Affiliations

  1. Medical ICU, Assistance Publique, Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, 75013, Paris, France

    Bertrand Guidet

  2. Department of Geriatrics, Sorbonne Université, Institut National de la Santé Et de la Recherche Médicale (INSERM), UMRS 1135, Centre d’immunologie et de Maladies Infectieuses (CIMI), Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), 75012, Paris, France

    Helene Vallet

  3. Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Department of Research and Development, Haukeland University Hospital, Bergen, Norway

    Hans Flaatten

  4. Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

    Gavin Joynt

  5. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada

    Sean M. Bagshaw

  6. George’s NHS Foundation Trust, London, UK

    Susannah K. Leaver

  7. Department of Medical Intensive Care, Faculty of Medicine, Hebrew University and Hadassah University Medical Center, Jerusalem, Israel

    Michael Beil

  8. Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Bin Du

  9. Departament of Emergency Medicine, Faculdade de Medicina, Universidade de São Paulo, Hospital Sírio-Libanês, São Paulo, Brazil

    Daniel N. Forte

  10. Critical Care Medicine, UPMC and University of Pittsburgh, Pittsburgh, USA

    Derek C. Angus

  11. Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Sigal Sviri

  12. Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands

    Dylan de Lange

  13. Interdepartmental Division of Critical Care Medicine, Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Institute of Medical Sciences, University of Toronto, Toronto, Canada

    Margaret S. Herridge

  14. Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany

    Christian Jung

Authors
  1. Bertrand Guidet
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  2. Helene Vallet
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  3. Hans Flaatten
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  4. Gavin Joynt
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  5. Sean M. Bagshaw
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  6. Susannah K. Leaver
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  7. Michael Beil
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  8. Bin Du
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  9. Daniel N. Forte
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  10. Derek C. Angus
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  11. Sigal Sviri
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  12. Dylan de Lange
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  13. Margaret S. Herridge
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  14. Christian Jung
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Corresponding author

Correspondence to Bertrand Guidet.

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Guidet, B., Vallet, H., Flaatten, H. et al. The trajectory of very old critically ill patients. Intensive Care Med 50, 181–194 (2024). https://doi.org/10.1007/s00134-023-07298-z

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