Advertisement

Intensive Care Medicine

, Volume 43, Issue 2, pp 217–219 | Cite as

Ten things to know about critically ill elderly patients

  • Guillaume Leblanc
  • Ariane Boumendil
  • Bertrand Guidet
What's New in Intensive Care

Introduction

The proportion of the world population aged 60 years or over is expected to increase from 12 % in 2013 to 21 % in 2050 [1]. This increase will represent more than 2 billion elders, including 400 million aged 80 years or over. As the population ages, intensive care units (ICU) are facing an increasing demand for care of the elderly [2], with patients aged 80 or over now representing 10–20 % of all ICU admissions.

1. The benefit of intensive care is controversial

Elderly patients have a higher prevalence of chronic diseases and an age-related diminution of physiological reserve, which makes them more vulnerable to acute illnesses. This vulnerability puts them at high risk of death when admitted to the ICU and potentially mitigates the benefits of intensive care. Observational studies demonstrated conflicting results on the matter, with decreased [3] or unchanged [4, 5] mortality in elderly patients admitted to the ICU versus those admitted elsewhere.

2. Few elements help ICU...

Keywords

Intensive Care Unit Intensive Care Unit Admission Intensive Care Unit Stay Intensive Care Unit Mortality Advanced Care Planning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    United Nations (2013) World population ageing 2013. Population Division of Department of Economic and Social Affairs New York. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf. Accessed 20 July 2016
  2. 2.
    Ihra GC, Lehberger J, Hochrieser H, Bauer P, Schmutz R, Metnitz B, Metnitz PG (2012) Development of demographics and outcome of very old critically ill patients admitted to intensive care units. Intensive Care Med 38:620–626CrossRefPubMedGoogle Scholar
  3. 3.
    Sprung CL, Artigas A, Kesecioglu J, Pezzi A, Wiis J, Pirracchio R, Baras M, Edbrooke DL, Pesenti A, Bakker J, Hargreaves C, Gurman G, Cohen SL, Lippert A, Payen D, Corbella D, Iapichino G (2012) The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly. Crit Care Med 40:132–138CrossRefPubMedGoogle Scholar
  4. 4.
    Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, Davido A, Masmoudi R, Doumenc B, Pateron D, Garrouste-Orgeas M, Somme D, Simon T, Aegerter P, Guidet B (2012) Variability of intensive care admission decisions for the very elderly. PLoS One 7:e34387CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Fuchs L, Novack V, McLennan S, Celi LA, Baumfeld Y, Park S, Howell MD, Talmor DS (2014) Trends in severity of illness on ICU admission and mortality among the elderly. PLoS One 9:e93234CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, Majumdar SR (2014) Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 186:E95–E102CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Le Maguet P, Roquilly A, Lasocki S, Asehnoune K, Carise E, Saint Martin M, Mimoz O, Le Gac G, Somme D, Cattenoz C, Feuillet F, Malledant Y, Seguin P (2014) Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med 40:674–682PubMedGoogle Scholar
  8. 8.
    Heyland DK, Garland A, Bagshaw SM, Cook D, Rockwood K, Stelfox HT, Dodek P, Fowler RA, Turgeon AF, Burns K, Muscedere J, Kutsogiannis J, Albert M, Mehta S, Jiang X, Day AG (2015) Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study. Intensive Care Med 41:1911–1920CrossRefPubMedGoogle Scholar
  9. 9.
    Sim YS, Jung H, Shin TR, Kim DG, Park SM (2015) Mortality and outcomes in very elderly patients 90 years of age or older admitted to the ICU. Respir Care 60:347–355CrossRefPubMedGoogle Scholar
  10. 10.
    Le Guen J, Boumendil A, Guidet B, Corvol A, Saint-Jean O, Somme D (2016) Are elderly patients’ opinions sought before admission to an intensive care unit? Results of the ICE-CUB study. Age Ageing 45:303–309CrossRefPubMedGoogle Scholar
  11. 11.
    Philippart F, Vesin A, Bruel C, Kpodji A, Durand-Gasselin B, Garcon P, Levy-Soussan M, Jagot JL, Calvo-Verjat N, Timsit JF, Misset B, Garrouste-Orgeas M (2013) The ETHICA study (part I): elderly’s thoughts about intensive care unit admission for life-sustaining treatments. Intensive Care Med 39:1565–1573CrossRefPubMedGoogle Scholar
  12. 12.
    Heyland DK, Dodek P, Mehta S, Cook D, Garland A, Stelfox HT, Bagshaw SM, Kutsogiannis DJ, Burns K, Muscedere J, Turgeon AF, Fowler R, Jiang X, Day AG (2015) Admission of the very elderly to the intensive care unit: family members’ perspectives on clinical decision-making from a multicenter cohort study. Palliat Med 29:324–335CrossRefPubMedGoogle Scholar
  13. 13.
    Garrouste-Orgeas M, Boumendil A, Pateron D, Aergerter P, Somme D, Simon T, Guidet B, ICE-CUB Group (2009) Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: an observational, multicenter, prospective study. Crit care Med 37:2919–2928CrossRefPubMedGoogle Scholar
  14. 14.
    Heyland D, Cook D, Bagshaw SM, Garland A, Stelfox HT, Mehta S, Dodek P, Kutsogiannis J, Burns K, Muscedere J, Turgeon AF, Fowler R, Jiang X, Day AG (2015) The very elderly admitted to ICU: a quality Finish? Crit Care Med 43:1352–1360CrossRefPubMedGoogle Scholar
  15. 15.
    Capuzzo M, Volta C, Tassinati T, Moreno R, Valentin A, Guidet B, Iapichino G, Martin C, Perneger T, Combescure C, Poncet A, Rhodes A (2014) Hospital mortality of adults admitted to intensive care units in hospitals with and without intermediate care units: a multicentre European cohort study. Crit Care 18:551CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hofhuis JG, van Stel HF, Schrijvers AJ, Rommes JH, Spronk PE (2015) ICU survivors show no decline in health-related quality of life after 5 years. Intensive Care Med 41:495–504CrossRefPubMedGoogle Scholar
  17. 17.
    Khouli H, Astua A, Dombrowski W, Ahmad F, Homel P, Shapiro J, Singh J, Nallamothu R, Mahbub H, Eden E, Delfiner J (2011) Changes in health-related quality of life and factors predicting long-term outcomes in older adults admitted to intensive care units. Crit Care Med 39:731–737CrossRefPubMedGoogle Scholar
  18. 18.
    Weiss L, Graf C, Herrmann F, Salomon R, Perrenoud JJ (2012) Intermediate geriatric care in Geneva: experience of ten years. Rev med Suisse 8:2133–2137PubMedGoogle Scholar
  19. 19.
    Andersen FH, Flaatten H, Klepstad P, Romild U, Kvale R (2015) Long-term survival and quality of life after intensive care for patients 80 years of age or older. Ann Intensive Care 5:53CrossRefPubMedGoogle Scholar
  20. 20.
    Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, Tayler C, Porterfield P, Sinuff T, Simon J, ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team, Canadian Researchers at the End of Life Network (CARENET) (2013) Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med 173:778–787CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Guillaume Leblanc
    • 1
    • 2
  • Ariane Boumendil
    • 2
  • Bertrand Guidet
    • 2
    • 3
    • 4
  1. 1.Department of Anesthesiology and Critical CareUniversité LavalQuebecCanada
  2. 2.Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP)Hôpital Saint-AntoineParisFrance
  3. 3.Sorbonne UniversitésUniversité Pierre et Marie Curie-Paris 06ParisFrance
  4. 4.Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_S 1136Institut Pierre Louis d’Épidémiologie et de Santé PubliqueParisFrance

Personalised recommendations