Management Issues in the Elderly

  • Paul Ellis Marik


People who are greater than 65 years of age are the fastest growing segment of the US population.1 By 2030 the population older than 65 years will double to approximately 70 million and the fastest growing segment of the population, those >84 years will triple. Age is associated with an increasing prevalence of multiple diseases and disabilities. Age is also associated with a decline in the functional reserve of multiple organ systems and a progressive restriction in personal and social resources. By virtue of have lived longer, increasing numbers of elderly patients (age >65 years) are being admitted to ICUs with diagnoses ranging from exacerbations of chronic illnesses and new onset of catastrophic health problems to trauma caused by home-related incidents and injury-resultant accidents that have occurred outside of the home. Elderly patients currently account for 42–52% of ICU admissions and for almost 60% of all ICU days.2 A disproportionate number of these ICU days are spent by elderly patients before their death. Forty percent of Medicare descendants are admitted to an ICU during their terminal illness, with descents accounting for one-quarter of all Medicare expenditure.3 Clearly ICU utilization by the elderly will increase exponentially over the next three decades.


Elderly Patient Diastolic Dysfunction Comprehensive Geriatric Assessment Sick Sinus Syndrome Lean Muscle Mass 
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.


  1. 1.
    Day JC. Population projections of the United States by age, sex, race and Hispanic origin: 1993–2050, Current Population Reports: US Department of Commerce Bureau of Census. 1993:25–1104.Google Scholar
  2. 2.
    Suresh R, Kupfer YY, Tessler S. The greying of the intensive care unit: demographic changes 1988–1998. Crit Care Med. 1999;27(Suppl):A27.CrossRefGoogle Scholar
  3. 3.
    Barnato AE, McClellan MB, Kagay CR, et al. Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life. Health Serv Res. 2004;39:363–375.PubMedCrossRefGoogle Scholar
  4. 4.
    Marik PE. Management of the critically Ill geriatric patient. Crit Care Med. 2006;34(Suppl):S176–S182.PubMedCrossRefGoogle Scholar
  5. 5.
    Holloszy JO. The biology of aging. Mayo Clin Proc. 2000;75(Suppl):S3–S8.PubMedGoogle Scholar
  6. 6.
    Lakatta EG. Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev. 2002;7:29–49.PubMedCrossRefGoogle Scholar
  7. 7.
    Salmasi AM, Alimo A, Jepson E, et al. Age-associated changes in left ventricular diastolic function are related to increasing left ventricular mass. Am J Hypertens. 2003;16:473–477.PubMedCrossRefGoogle Scholar
  8. 8.
    Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001;344:17–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Swinne CJ, Shapiro EP, Lima SD, et al. Age-associated changes in left ventricular diastolic performance during isometric exercise in normal subjects. Am J Cardiol. 1992;69:823–826.PubMedCrossRefGoogle Scholar
  10. 10.
    Kannel WB, Dannenberg AL, Abbott RD. Unrecognized myocardial infarction and hypertension: the Framingham Study. Am Heart J. 1985;109:581–585.PubMedCrossRefGoogle Scholar
  11. 11.
    Marik PE. Aspiration pneumonitis and pneumonia: a clinical review. N Engl J Med. 2001;344:665–672.PubMedCrossRefGoogle Scholar
  12. 12.
    Saltzman RL, Peterson PK. Immunodeficiency of the elderly. Rev Infect Dis. 1987;9:1127–1139.PubMedCrossRefGoogle Scholar
  13. 13.
    Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34:15–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Bochicchio GV, Joshi M, Knorr KM, et al. Impact of nosocomial infections in trauma: does age make a difference? J Trauma. 2001;50:612–617.PubMedCrossRefGoogle Scholar
  15. 15.
    Mayer-Oakes SA, Oye RK, Leake B. Predictors of mortality in older patients following medical intensive care: the importance of functional status. J Am Geriatr Soc. 1991;39:862–868.PubMedGoogle Scholar
  16. 16.
    Nicolas F, Le GJR, Alperovitch A, et al. Influence of patients’ age on survival, level of therapy and length of stay in intensive care units. Intensive Care Med. 1987;13:9–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Somme D, Maillet JM, Gisselbrecht M, et al. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med. 2003;29:2137–2143.PubMedCrossRefGoogle Scholar
  18. 18.
    Rady MY, Johnson DJ. Hospital discharge to care facility: a patient-centered outcome for the evaluation of intensive care for octogenarians. Chest. 2004;126:1583–1591.PubMedCrossRefGoogle Scholar
  19. 19.
    Kaarlola A, Tallgren M, Pettila V. Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med. 2006;34:2120–2126.PubMedCrossRefGoogle Scholar
  20. 20.
    Mandavia D, Newton K. Geriatric trauma. Emerg Med Clin North Am. 1998;16:257–274.PubMedCrossRefGoogle Scholar
  21. 21.
    Perdue PW, Watts DD, Kaufmann CR, et al. Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death. J Trauma. 1998;45:805–810.PubMedCrossRefGoogle Scholar
  22. 22.
    Barlow AP, Zarifa Z, Shillito RG, et al. Surgery in a geriatric population. Ann R Coll Surg Engl. 1989;71:110–114.PubMedGoogle Scholar
  23. 23.
    Liu LL, Leung JM. Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc. 2000;48:405–412.PubMedGoogle Scholar
  24. 24.
    Lawrence VA, Hazuda HP, Cornell JE, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004;199:762–772.PubMedCrossRefGoogle Scholar
  25. 25.
    Rady MY, Johnson DJ. Cardiac surgery for octogenarians: is it an informed decision? Am Heart J. 2004;147:347–353.PubMedCrossRefGoogle Scholar
  26. 26.
    Fukuse T, Satoda N, Hijiya K, et al. Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest. 2005;127:886–891.PubMedCrossRefGoogle Scholar
  27. 27.
    Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002;20:494–502.PubMedCrossRefGoogle Scholar
  28. 28.
    Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International study of post-operative cognitive dysfunction. Lancet. 1998;351:857–861.PubMedCrossRefGoogle Scholar
  29. 29.
    Santos FS, Velasco IT, Fraguas R Jr. Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Int Psychogeriatr. 2004;16:175–193.PubMedCrossRefGoogle Scholar
  30. 30.
    Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344:395–402.PubMedCrossRefGoogle Scholar
  31. 31.
    Onder G, Pedone C, Landi F, et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc. 2002;50:1962–1968.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations