Intensive Care Medicine

, 33:1252 | Cite as

Should elderly patients be admitted to the intensive care unit?

  • Ariane Boumendil
  • Dominique Somme
  • Maïté Garrouste-Orgeas
  • Bertrand GuidetEmail author


As the general population ages, an increasing number of patients over 80 years are being admitted to the intensive care unit (ICU). Selection of older patients for ICU admission results in lower rates of co-morbidities and underlying fatal diseases. After adjustment for disease severity, ICU and post-ICU mortality rates are higher in elderly patients than in younger populations. Age itself explains only a  small part of the increased hospital mortality, suggesting that specific information such as functional, cognitive, and nutritional status, as well as co-morbidities, should be collected to predict mortality in elderly ICU patients. The long-term prognosis depends chiefly on functional status, whereas initial disease severity no longer influences mortality. According to our review, it is impossible to define evidence-based recommendations for ICU admission of the elderly. This justifies further studies that encompass several aspects, such as the initial triage process and the long-term prognosis (mortality, autonomy and quality of life).


Critical care Aged, 80 and over Longevity Triage Quality of life Ethics, clinical 


  1. 1.
    Brutel C, Omalek L (2003) Projections démographiques pour la France, ses régions et ses départements (horizon 2030, 2050). Insee Résultats—société 16:8–17Google Scholar
  2. 2.
    Department of Economic and Social Affairs PD (2001) World population ageing: 1950–2050. United Nations, New YorkGoogle Scholar
  3. 3.
    Valleron AJ, Boumendil A (2004) [Epidemiology and heat waves: analysis of the 2003 episode in France]. C R Biol 327:1125–1141PubMedGoogle Scholar
  4. 4.
    Rockwood K (2005) Frailty and its definition: a worthy challenge. J Am Geriatr Soc 53:1069–1070CrossRefPubMedGoogle Scholar
  5. 5.
    Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr., Walston JD (2004) Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 52:625–634CrossRefPubMedGoogle Scholar
  6. 6.
    Fried LP, Kronmal RA, Newman AB, Bild DE, Mittelmark MB, Polak JF, Robbins JA, Gardin JM (1998) Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. JAMA 279:585–592CrossRefPubMedGoogle Scholar
  7. 7.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–156CrossRefPubMedGoogle Scholar
  8. 8.
    Boockvar KS, Meier DE (2006) Palliative care for frail older adults: “there are things I can't do anymore that I wish I could.” JAMA 296:2245–2253CrossRefPubMedGoogle Scholar
  9. 9.
    Direction des Statistiques et des Etudes (2003) Le vieillissement de la population et son incidence sur l'évolution des dépenses de santé. Caisse National d'assurance Maladie des Travailleurs Salariés. Points de conjoncture 15:17–27Google Scholar
  10. 10.
    Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, Rubenfeld GD (2004) Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 32:638–643CrossRefPubMedGoogle Scholar
  11. 11.
    Cook D, Giacomini M (1999) The sound of silence: rationing resources for critically ill patients. Crit Care (Lond) 3:R1–R3CrossRefGoogle Scholar
  12. 12.
    Rivlin M (1999) Should age based rationing of health care be illegal? BMJ 319:1379CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fairhead JF, Rothwell PM (2006) Underinvestigation and undertreatment of carotid disease in elderly patients with transient ischaemic attack and stroke: comparative population based study. BMJ 333:525–527CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Callahan D (1987) Setting limits: medical goals in an aging society. Simon and Schuster, New YorkGoogle Scholar
  15. 15.
    SCCM EC (1994) Consensus statement on the triage of critically ill patients. JAMA 271:1200–1203CrossRefGoogle Scholar
  16. 16.
    Hofmann JC, Wenger NS, Davis RB, Teno J, Connors AF Jr., Desbiens N, Lynn J, Phillips RS (1997) Patient preferences for communication with physicians about end-of-life decisions. SUPPORT Investigators. Study to Understand Prognoses and Preference for Outcomes and Risks of Treatment. Ann Intern Med 127:1–12CrossRefPubMedGoogle Scholar
  17. 17.
    Ferrand E, Robert R, Ingrand P, Lemaire F (2001) Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. French LATAREA Group. Lancet 357:9–14CrossRefPubMedGoogle Scholar
  18. 18.
    Hamel MB, Teno JM, Goldman L, Lynn J, Davis RB, Galanos AN, Desbiens N, Connors AF Jr., Wenger N, Phillips RS (1999) Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Ann Intern Med 130:116–125CrossRefPubMedGoogle Scholar
  19. 19.
    Tsevat J, Dawson NV, Wu AW, Lynn J, Soukup JR, Cook EF, Vidaillet H, Phillips RS (1998) Health values of hospitalized patients 80 years or older. HELP Investigators. Hospitalized Elderly Longitudinal Project. JAMA 279:371–375CrossRefPubMedGoogle Scholar
  20. 20.
    Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste M, Cohen Y, Thuong M, Paugam C, Apperre C, De Cagny B, Brun F, Bornstain C, Parrot A, Thamion F, Lacherade J, Bouffard Y, Le Gall J, Herve C, Grassin M, Zittoun R, Schlemmer B, Dhainaut JF (2001) Compliance with triage to intensive care recommendations. Crit Care Med 29:2132–2136CrossRefPubMedGoogle Scholar
  21. 21.
    Garrouste-Orgeas M, Montuclard L, Timsit JF, Misset B, Christias M, Carlet J (2003) Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes. Intensive Care Med 29:774–781CrossRefPubMedGoogle Scholar
  22. 22.
    Garrouste-Orgeas M, Montuclard L, Timsit JF, Reignier J, Desmettre T, Karoubi P, Moreau D, Montesino L, Duguet A, Boussat S, Ede C, Monseau Y, Paule T, Misset B, Carlet J (2005) Predictors of intensive care unit refusal in French intensive care units: a multiple-center study. Crit Care Med 33:750–755CrossRefPubMedGoogle Scholar
  23. 23.
    Joynt GM, Gomersall CD, Tan P, Lee A, Cheng CA, Wong EL (2001) Prospective evaluation of patients refused admission to an intensive care unit: triage, futility and outcome. Intensive Care Med 27:1459–1465CrossRefPubMedGoogle Scholar
  24. 24.
    Metcalfe MA, Slogget A, McPherson K (1997) Mortality among approprietly referred patients refused admission to intensive-care units. Lancet 350:7–11CrossRefPubMedGoogle Scholar
  25. 25.
    Frisho-Lima P, Gurman G, Schapira A, Porath A (1994) Rationing critical care—what happens to patients who are not admitted? Theor Surg 9:208–211PubMedGoogle Scholar
  26. 26.
    Sprung CL, Geber D, Eidelman LA, Baras M, Pizov R, Nimrod A, Oppenheim A, Epstein L, Cotev S (1999) Evaluation of triage decisions for intensive care admission. Crit Care Med 27:1073–1079CrossRefPubMedGoogle Scholar
  27. 27.
    Escher M, Perneger TV, Chevrolet JC (2004) National questionnaire survey on what influences doctors' decisions about admission to intensive care. BMJ 329:425–430CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Levin PD, Sprung CL (2001) The process of intensive care triage. Intensive Care Med 27:1441–1445CrossRefPubMedGoogle Scholar
  29. 29.
    Einav S, Soudry E, Levin PD, Grunfeld GB, Sprung CL (2004) Intensive care physicians' attitudes concerning distribution of intensive care resources. A comparison of Israeli, North American and European cohorts. Intensive Care Med 30:1140–1143CrossRefPubMedGoogle Scholar
  30. 30.
    SCCM T (1999) Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med 27:633–638CrossRefGoogle Scholar
  31. 31.
    Sprung CL, Eidelman (1997) Triage decisions for intensive care in terminally ill patients. Intensive Care Med 23:1011–1014CrossRefPubMedGoogle Scholar
  32. 32.
    Garrouste-Orgeas M, Timsit JF, Montuclard L, Colvez A, Gattolliat O, Philippart F, Rigal G, Misset B, Carlet J (2006) Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med 32:1045–1051CrossRefPubMedGoogle Scholar
  33. 33.
    Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413CrossRefPubMedGoogle Scholar
  34. 34.
    Nierman DM, Schechter CB, Cannon LM, Meier DE (2001) Outcome prediction model for very elderly critically ill patients. Crit Care Med 29:1853–1859CrossRefPubMedGoogle Scholar
  35. 35.
    Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29:2137–2143CrossRefPubMedGoogle Scholar
  36. 36.
    Boumendil A, Maury E, Reinhard I, Luquel L, Offenstadt G, Guidet B (2004) Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 30:647–654CrossRefPubMedGoogle Scholar
  37. 37.
    Boumendil A, Aegerter P, Guidet B (2005) Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc 53:88–93CrossRefPubMedGoogle Scholar
  38. 38.
    Kass JE, Castriotta RJ, Malakoff F (1992) Intensive care unit outcome in the very elderly. Crit Care Med 20:1666–1671CrossRefPubMedGoogle Scholar
  39. 39.
    Kleinpell R, Ferrans C (1998) Factors influencing intensive care unit survival for critically ill elderly patients. Heart Lung 27:337–343CrossRefPubMedGoogle Scholar
  40. 40.
    Bo M, Massaia M, Raspo S, Bosco F, Cena P, Molaschi M, Fabris F (2003) Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit. J Am Geriatr Soc 51:529–533CrossRefPubMedGoogle Scholar
  41. 41.
    Aegerter P, Boumendil A, Retbi A, Minvielle E, Dervaux B, Guidet B (2005) SAPS II revisited. Intensive Care Med 31:416–423CrossRefPubMedGoogle Scholar
  42. 42.
    Ip SP, Leung YF, Ip CY, Mak WP (1999) Outcomes of critically ill elderly patients: is high-dependency care for geriatric patients worthwhile? Crit Care Med 27:2351–2357CrossRefPubMedGoogle Scholar
  43. 43.
    Dragsted L, Qvist J (1992) Epidemiology of intensive care. Int J Technol Assess Health Care 8:395–407CrossRefPubMedGoogle Scholar
  44. 44.
    Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J (1993) Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270:2478–2486CrossRefPubMedGoogle Scholar
  45. 45.
    Cheng IW, Matthay MA (2003) Acute lung injury and the acute respiratory distress syndrome. Crit Care Clin 19:693–712CrossRefPubMedGoogle Scholar
  46. 46.
    Ely EW, Wheeler AP, Thompson BT, Ancukiewicz M, Steinberg KP, Bernard GR (2002) Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome. Ann Intern Med 136:25–36CrossRefPubMedGoogle Scholar
  47. 47.
    Carson SS (2003) The epidemiology of critical illness in the elderly. Crit Care Clin 19:605–617CrossRefPubMedGoogle Scholar
  48. 48.
    Ely EW, Evans GW, Haponik EF (1999) Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Ann Intern Med 131:96–104CrossRefPubMedGoogle Scholar
  49. 49.
    Metnitz PG, Fieux F, Jordan B, Lang T, Moreno R, Le Gall JR (2003) Critically ill patients readmitted to intensive care units—lessons to learn? Intensive Care Med 29:241–248CrossRefPubMedGoogle Scholar
  50. 50.
    Metnitz PG, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le Gall JR (2005) SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 1. Objectives, methods and cohort description. Intensive Care Med 31:1336–1344CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Rosenthal GE, Kaboli PJ, Barnett MJ, Sirio CA (2002) Age and the risk of in-hospital death: insights from a multihospital study of intensive care patients. J Am Geriatr Soc 50:1205–1212CrossRefPubMedGoogle Scholar
  52. 52.
    Teno JM, Harrell FEJ, Knaus W, Phillips RS, Wu AW, Connors AJ, Wenger NS, Wagner D, Galanos A, Desbiens NA, Lynn J (2000) Prediction of survival for older hospitalized patients: the HELP survival model. Hospitalized Elderly Longitudinal Project. J Am Geriatr Soc 48:S16–24CrossRefPubMedGoogle Scholar
  53. 53.
    Keenan SP, Dodek P, Chan K, Hogg RS, Craib KJ, Anis AH, Spinelli JJ (2002) Intensive care unit admission has minimal impact on long-term mortality. Crit Care Med 30:501–507CrossRefPubMedGoogle Scholar
  54. 54.
    Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 51:451–458CrossRefPubMedGoogle Scholar
  55. 55.
    Rady MY, Johnson DJ (2004) Hospital discharge to care facility: a patient-centered outcome for the evaluation of intensive care for octogenarians. Chest 126:1583–1591CrossRefPubMedGoogle Scholar
  56. 56.
    Covinsky KE, Wu AW, Landefeld CS, Connors AF Jr., Phillips RS, Tsevat J, Dawson NV, Lynn J, Fortinsky RH (1999) Health status versus quality of life in older patients: does the distinction matter? Am J Med 106:435–440CrossRefPubMedGoogle Scholar
  57. 57.
    Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727CrossRefPubMedGoogle Scholar
  58. 58.
    Bucquet D, Condon S, Ritchie K (1990) The French version of the Nottingham Health Profile. A comparison of items weights with those of the source version. Soc Sci Med 30:829–835CrossRefPubMedGoogle Scholar
  59. 59.
    Ware JE Jr., Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMedGoogle Scholar
  60. 60.
    Borglin G, Edberg AK, Hallberg IL (2005) The experience of quality of life among older people. J Aging Studies 19:201–220CrossRefGoogle Scholar
  61. 61.
    Nilsson M, Ekman SL, Sarvimäki A (1998) Ageing with joy or resigning to old age: older people's experiences of their quality of life. Health Care in Later Life 3:94–110Google Scholar
  62. 62.
    Nilsson M, Ekman SL, Ericsson K, Winblad B (1996) Some characteristics of the quality of life in old age illustrated by means of Allardt's concept. Scand J Caring Sci 10:116–121CrossRefPubMedGoogle Scholar
  63. 63.
    Covinsky KE, Kahana E, Chin MH, Palmer RM, Fortinsky RH, Landefeld CS (1999) Depressive symptoms and 3-year mortality in older hospitalized medical patients. Ann Intern Med 130:563–569CrossRefPubMedGoogle Scholar
  64. 64.
    Kleinpell RM, Ferrans CE (2002) Quality of life of elderly patients after treatment in the ICU. Res Nurs Health 25:212–221CrossRefPubMedGoogle Scholar
  65. 65.
    Chelluri L, Pinsky MR, Donahoe MP, Grenvik A (1993) Long-Term Outcome of Critically Ill Elderly Patients Requiring Intensive Care. JAMA 269:3119–3123CrossRefPubMedGoogle Scholar
  66. 66.
    McHugh GJ, Havill JH, Armistead SH, Ullal RR, Fayers TM (1997) Follow up of elderly patients after cardiac surgery and intensive care unit admission, 1991 to 1995. N Z Med J 110:432–435PubMedGoogle Scholar
  67. 67.
    Sjogren J, Thulin LI (2004) Quality of life in the very elderly after cardiac surgery: a comparison of SF-36 between long-term survivors and an age-matched population. Gerontology 50:407–410CrossRefPubMedGoogle Scholar
  68. 68.
    Udekwu P, Gurkin B, Oller D, Lapio L, Bourbina J (2001) Quality of life and functional level in elderly patients surviving surgical intensive care. J Am Coll Surg 193:245–249CrossRefPubMedGoogle Scholar
  69. 69.
    Broslawski GE, Elkins M, Algus M (1995) Functional abilities of elderly survivors of intensive care. J Am Osteopath Assoc 95:712–717PubMedGoogle Scholar
  70. 70.
    Chelluri L, Pinsky MR, Grenvik AN (1992) Outcome of intensive care of the “oldest-old” critically ill patients. Crit Care Med 20:757–761CrossRefPubMedGoogle Scholar
  71. 71.
    Mahul P, Perrot D, Tempelhoff G, Gaussorgues P, Jospe R, Ducreux JC, Dumont A, Motin J, Auboyer C, Robert D (1991) Short- and long-term prognosis, functional outcome following ICU for elderly. Intensive Care Med 17:7–10CrossRefPubMedGoogle Scholar
  72. 72.
    Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonghe B, Carlet J (2000) Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med 28:3389–3395CrossRefPubMedGoogle Scholar
  73. 73.
    Rockwood K, Noseworthy TW, Gibney RT, Konopad E, Shustack A, Stollery D, Johnston R, Grace M (1993) One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med 21:687–691CrossRefPubMedGoogle Scholar
  74. 74.
    Levy CR, Ely EW, Payne K, Engelberg RA, Patrick DL, Curtis JR (2005) Quality of dying and death in two medical ICUs: perceptions of family and clinicians. Chest 127:1775–1783CrossRefPubMedGoogle Scholar
  75. 75.
    de Rooij SE, Govers A, Korevaar JC, Abu-Hanna A, Levi M, de Jonge E (2006) Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med 32:1039–1044CrossRefPubMedGoogle Scholar
  76. 76.
    Torres OH, Francia E, Longobardi V, Gich I, Benito S, Ruiz D (2006) Short- and long-term outcomes of older patients in intermediate care units. Intensive Care Med 32:1052–1059CrossRefPubMedGoogle Scholar
  77. 77.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186CrossRefPubMedGoogle Scholar
  78. 78.
    Sheikh RL, Yesavage JA (1986) Geriatric Depression Scale (GDS). Recent Evidence and Development of a Shorter Version. Clin Gerontologist 5:165–173CrossRefGoogle Scholar
  79. 79.
    Patrick DL, Danis M, Southerland LI, Hong G (1988) Quality of life following intensive care. J Gen Intern Med 3:218–223CrossRefPubMedGoogle Scholar
  80. 80.
    Ferrans CE, Powers MJ (1992) Psychometric assessment of the Quality of Life Index. Res Nurs Health 15:29–38CrossRefPubMedGoogle Scholar
  81. 81.
    Bergner M, Bobbitt RA, Carter WB, Gilson BS (1981) The Sickness Impact Profile: development and final revision of a health status measure. Med Care 19:787–805CrossRefPubMedGoogle Scholar
  82. 82.
    Demoule A, Cracco C, Lefort Y, Ray P, Derenne JP, Similowski T (2005) Patients aged 90 years or older in the intensive care unit. J Gerontol A Biol Sci Med 60:129–132CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Ariane Boumendil
    • 1
    • 2
  • Dominique Somme
    • 3
  • Maïté Garrouste-Orgeas
    • 4
  • Bertrand Guidet
    • 1
    • 2
    • 5
    Email author
  1. 1.Faculté de médecine St AntoineINSERM, U707ParisFrance
  2. 2.Université Pierre et Marie Curie, Paris 6, UMR S U707ParisFrance
  3. 3.Geriatric UnitAP-HP, Hôpital Européen Georges PompidouParis cedex 15France
  4. 4.Intensive Care UnitFondation Hôpital Saint JosephParisFrance
  5. 5.Medical Intensive Care UnitAP-HP, Hôpital St. AntoineParisFrance

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