The Very Old Critically Ill Patients

1. Front Matter

   Pages I-XXVII

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2. Introduction: The Very Old ICU Patients

   1. Front Matter

      Pages 1-1

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   2. The Demography of Ageing and the Very Old Critical Ill Patients

      • Hans Flaatten, Bertrand Guidet, Hélène Vallet

      Pages 3-10

   3. Objectives of ICU Management for Very Old Patients

      • Margaux Baqué, Sara Thietart, Judith Cohen-Bittan, Marc Verny, Lorène Zerah, Jacques Boddaert

      Pages 11-19

3. Age-Related Physiological Changes

   1. Front Matter

      Pages 21-21

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   2. Aged-Related Physiological Changes: CNS Function

      • Stéphanie Miot, Raphaël Chancel, Hubert Blain

      Pages 23-42

   3. Age-Related Physiology Changes: Cardiovascular Function in the Very Old Critically Ill Patient

      • E. Skaar, H. Fanebust, G. Schwarz

      Pages 43-58

   4. Age-Related Changes of the Kidneys and their Physiological Consequences

      • Fabian Perschinka, Timo Mayerhöfer, Michael Joannidis

      Pages 59-68

   5. Immunological Changes

      • Tamas Fulop, Anis Larbi, Abdelouahed Khalil, Katsuiku Hirokawa, Alan A. Cohen, Jacek M. Witkowski

      Pages 69-90

   6. Drug Metabolism

      • Saskia Rietjens, Dylan de Lange

      Pages 91-107

4. Geriatric Syndroms

   1. Front Matter

      Pages 109-109

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   2. Multimorbidity

      • Claire Roubaud-Baudron, Florent Guerville

      Pages 111-122

   3. Multipharmacy on the Older Adult

      • Lozano Vicario Lucía, Gutiérrez-Valencia Marta, Martínez-Velilla Nicolas

      Pages 123-143

   4. Sarcopenia: An Overview

      • Laura Orlandini, Tiziano Nestola, Matteo Cesari

      Pages 145-163

   5. Geriatric Syndromes: Frailty

      • R. Walford, T. Lawton, A. Clegg

      Pages 165-180

   6. Malnutrition

      • Lahaye Clement

      Pages 181-197

   7. Functional Status and Older Age

      • Nazir I. Lone, Lisa Salisbury, Atul Anand

      Pages 199-218

   8. Comprehensive Geriatric Assessment (CGA)

      • Hélène Vallet, Céline Bianco, Caroline Thomas

      Pages 219-228

5. Triage

   1. Front Matter

      Pages 229-229

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   2. Pre-ICU Triage: The Very Old Critically Ill Patient

      • Gavin M. Joynt

      Pages 231-250

This book, part of the European Society of Intensive Care Medicine (ESICM) textbook series, provides detailed up-to-date information on the care of the critical ill very old (≥80 years) patients in the ICU.

The very old are expanding fast in our populations, and this is mirrored in our hospitals and ICUs as well. During the last decade, a lot more information about the group of critical ill elderly has been published, and several large networks cooperate in performing multinational studies in this field, one of them with roots in the ESICM. This book will give readers knowledge about the current epidemiology of elderly ICU patients, in  patients centered outcomes and factors affecting these outcomes. A large part is devoted to age related changes in vital organ functions, and the specific geriatric “syndromes” like frailty, cognitive decline, reduced activity of daily living, sarcopenia and immunosenecence. This is all important for the practicing intensivists to know about. In addition, specific groups of the elderly in the ICU are also described like the elderly patients with trauma or sepsis.

The book is written jointly by intensivists and geriatricians, often working in teams and originating from many different countries. This herald a new era in the collaboration between these two groups in order to improve care and rehabilitation. We have a lot to learn from each other, as both groups have a holistic view of our patients although with different perspectives.

This book should be of value for all working in adult ICUs, physicians as well as nurses. It will hopefully lead to a better understanding of the particular challenges posed by this important sub-group of ICU patients and how to manage his group in a way that combine respect for life as well as death and includes patients and caregivers in this process.

• Critical care
• Elderly
• Geriatric assessment
• Shared decision-making
• Prognostication

• Faculty of Medicine, Department of Clinical Medicine and Department of Anaesthesia and Intensive Care, University of Bergen and Haukeland University Hospital, Bergen, Norway

  Hans Flaatten

• Sorbonne Université, INSERM Institut Pierre Louis d’Epidémiologie et de, Santé Publique, AP-HP, Hôpital Saint Antoine, Paris, France

  Bertrand Guidet

• Sorbonne Université, Hôpital Saint Antoine Unité de Gériatrie Aiguë, Assistance Publique, Hôpitaux de Paris, Paris, France

  Hélène Vallet

Professor Hans Flaatten is professor in Intensive Care Medicine at Haukeland University Hospital. He was Medical director of the ICU from 1994 to 2004 and now is senior consultant in Intensive Care part time. He was specialist in Anaesthesia and Intensive Care in 1986, and have since mainly worked in Bergen. He has a PhD in medicine from 1998, and was professor in Intensive care Medicine from 2004 at the University of Bergen. In 2013, he was visiting Scholar at the Chinese University in Hong Kong: Prince of Wales Hospital. The main interests in intensive care has been education and training, outcomes after intensive care and quality management. He served as head of the Division of Education and Training in the European Society of Intensive Care Medicine (ESICM) from 2007-2009 and as Chair of the Section of Health Service and Outcome 2009-2012. In 2017 he was awarded honorary membership in ESICM. He was also President for the Scandinavian Society and Intensive care Medicine Congress in Bergen 2011. He has 215 publications on PubMed and  research activity the last years have a focus on the very old patients in the ICU, mainly as PI of the so-called VIP network with around 300 ICUs around Europe and elsewhere conducting large scale collaborative studies in this field.

Professor Bertrand Guidet is the director of the Medical Intensive Care at the Hôpital Saint Antoine in Paris, France. He gained his Medical Doctors degree in 1985. In 1987, he joined the Medical Intensive Care Board. In 1993 he gained the necessary qualifications to perform research direction. He has been a university medical professor since 1997. Professor Guidet is also a member of the research unit INSERM U1136 at the National Institute for Health and Medical Research (INSERM), which is a French public organization entirely dedicated to biological, medical and public health research. He was medical director of the Est Paris Area group of hospitals from 2011 to 2019. He is the past President (2008-2010) of the French Society for Intensive Care (SRLF) and is currently a member of the Health Research and Services outcome section of the European Society of Intensive Care Medicine (ESICM). In 2019 he was awarded honorary membership in ESICM. Professor Guidet has written 375 articles published in national and international journals. He worked on the critically-ill older patients since almost 20 years and was the PI of several national and international studies.

Doctor Hélène Vallet work as geriatrician in the acute geriatric centre of Saint Antoine Hospital (Paris) since 2019. She obtained her Medical Doctor degree in 2014 and is specialized in internal medicine and geriatric medicine. She also graduated with PhD in immunology since 2019. Her interest areas are acute stress in older patients notably after intensive care and surgery.

Doctor Hélène Vallet is also a member of the research unit INSERM U1135 at the National Institute for Health and Medical Research (INSERM), and interested since 4 years about the impact of acute stress on senescent immune system. She is member of the French National Society of Geriatrics and Gerontology (SFGG) and of the European Academy for Medicine of Ageing (EAMA).  Doctor Hélène Vallet has written 24 articles published in national and international journals and is co-responsible of a national university diploma about intensive care and anesthesia in older patients at Sorbonne University.