Skip to main content
SpringerLink
Log in

Critical Care in Older Adults

  • Chapter
  • First Online:
Geriatric Urology

  • 1067 Accesses

Abstract

Geriatric patients constitute a substantial proportion of those utilizing critical care services in acute care hospital settings. This chapter reviews clinical indications for critical care services in this population. Specific treatments are reviewed in the context of overall care, including care at the end of life. Critical care medicine plays an important role in the management of elderly urologic patients with complex care requirements.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Udekwu P, Gurkin B, Oller D, Lapio L, Bourbina J. Quality of life and functional level in elderly patients surviving surgical intensive care. J Am Coll Surg. 2001;193(3):245–9.

    Article  CAS  PubMed  Google Scholar 

  2. Menaker J, Scalea TM. Geriatric care in the surgical intensive care unit. Crit Care Med. 2010;38(9 Suppl):S452–9.

    Article  PubMed  Google Scholar 

  3. Aging Statistics, Administration on Aging. http://www.aoa.gov/Aging_Statistics/.

  4. U.S. Census Bureau. United States Census 2000. Washington, DC: US Census Bureau; 2000.

    Google Scholar 

  5. Ito Y, Kenmochi T, Irino T, et al. The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol. 2011;9:102. doi:10.1186/1477-7819-9-102; 10.1186/1477-7819-9-102.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Zoller DP. The physiology of aging. Am Fam Physician. 1987;36(1):112–6.

    CAS  PubMed  Google Scholar 

  7. Evers BM, Townsend CM, Thompson JC. Organ physiology of aging. Surg Clin North Am. 1994;1(74):23–39.

    Google Scholar 

  8. Lakatta EG. Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev. 2002;7(1):29–49.

    Article  PubMed  Google Scholar 

  9. Goldman L, Caldera DL, Southwick FS, et al. Cardiac risk factors and complications in non-cardiac surgery. Medicine (Baltimore). 1978;57(4):357–70.

    Article  CAS  Google Scholar 

  10. Tresch DD, McGough MF. Heart failure with normal systolic function: a common disorder in older people. J Am Geriatr Soc. 1995;43(9):1035–42.

    CAS  PubMed  Google Scholar 

  11. Marik PE. Management of the critically ill geriatric patient. Crit Care Med. 2006;34(9 Suppl):S176–82. doi:10.1097/01.CCM.0000232624.14883.9A.

    Article  PubMed  Google Scholar 

  12. Morley JE, Reese SS. Clinical implications of the aging heart. Am J Med. 1989;86(1):77–86.

    Article  CAS  PubMed  Google Scholar 

  13. Tockman M. Aging of the respiratory system. In: Katlic M, editor. Geriatric surgery, comprehensive care of the elderly patient. Baltimore-Munich: Urban & Schwarzenberg; 1990. p. 75–84.

    Google Scholar 

  14. Dhar S, Shastri SR, Lenora RA. Aging and the respiratory system. Med Clin North Am. 1976;60(6):1121–39.

    CAS  PubMed  Google Scholar 

  15. Morris JF, Koski A, Johnson LC. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis. 1971;103(1):57–67.

    CAS  PubMed  Google Scholar 

  16. Kronenberg RS, Drage CW. Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. J Clin Invest. 1973;52(8):1812–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Pisani MA. Considerations in caring for the critically ill older patient. J Intensive Care Med. 2009;24(2):83–95.

    Article  PubMed  Google Scholar 

  18. Adler S, Lindeman RD, Yiengst MJ, Beard E, Shock NW. Effect of acute acid loading on urinary acid excretion by the aging human kidney. J Lab Clin Med. 1968;72(2):278–89.

    CAS  PubMed  Google Scholar 

  19. Liu LL, Leung JM. Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc. 2000;48(4):405–12.

    CAS  PubMed  Google Scholar 

  20. Keller SM, Markovitz LJ, Wilder JR, Aufses Jr AH. Emergency and elective surgery in patients over age 70. Am Surg. 1987;53(11):636–40.

    CAS  PubMed  Google Scholar 

  21. Scalea TM, Simon HM, Duncan AO, et al. Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma. 1990;30(2):129–34. discussion 134-6.

    Article  CAS  PubMed  Google Scholar 

  22. Clermont G, Kong L, Weissfeld LA, et al. The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. PLoS One. 2011;6(7):e22512.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–24.

    Article  PubMed  Google Scholar 

  24. Harvey S, Stevens K, Harrison D, et al. An evaluation of the clinical and cost-effectiveness of pulmonary artery catheters in patient management in intensive care: a systematic review and a randomised controlled trial. Health Technol Assess. 2006;10(29):iii–iv, ix–xi, 1–133.

    Google Scholar 

  25. Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348(1):5–14.

    Article  PubMed  Google Scholar 

  26. Richard C, Monnet X, Teboul JL. Pulmonary artery catheter monitoring in 2011. Curr Opin Crit Care. 2011;17(3):296–302.

    Article  PubMed  Google Scholar 

  27. Levy MM, Dellinger RP, Townsend SR, et al. The surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367–74.

    Article  PubMed  Google Scholar 

  28. Durairaj L, Schmidt GA. Fluid therapy in resuscitated sepsis: less is more. Chest. 2008;133(1):252–63.

    Article  PubMed  Google Scholar 

  29. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.

    Article  CAS  PubMed  Google Scholar 

  30. Wiesenack C, Prasser C, Rodig G, Keyl C. Stroke volume variation as an indicator of fluid responsiveness using pulse contour analysis in mechanically ventilated patients. Anesth Analg. 2003;96(5):1254–7.

    Article  PubMed  Google Scholar 

  31. Greenfield N, Balk RA. Evaluating the adequacy of fluid resuscitation in patients with septic shock: controversies and future directions. Hosp Pract (1995). 2012;40(2):147–57.

    Article  Google Scholar 

  32. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288(17):2151–62.

    Article  PubMed  Google Scholar 

  33. Watters JM, Bessey PQ. Critical care for the elderly patient. Surg Clin North Am. 1994;74(1):187–97.

    CAS  PubMed  Google Scholar 

  34. Heidegger CP, Darmon P, Pichard C. Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred. Curr Opin Crit Care. 2008;14(4):408–14.

    Article  PubMed  Google Scholar 

  35. Bistrian BR, McCowen KC. Nutritional and metabolic support in the adult intensive care unit: key controversies. Crit Care Med. 2006;34(5):1525–31.

    Article  PubMed  Google Scholar 

  36. Alpers DH. Enteral feeding and gut atrophy. Curr Opin Clin Nutr Metab Care. 2002;5(6):679–83.

    Article  CAS  PubMed  Google Scholar 

  37. Phelps SJ, Brown RO, Helms RA, Christensen ML, Kudsk K, Cochran EB. Toxicities of parenteral nutrition in the critically ill patient. Crit Care Clin. 1991;7(3):725–53.

    CAS  PubMed  Google Scholar 

  38. Doig GS. Parenteral versus enteral nutrition in the critically ill patient: additional sensitivity analysis supports benefit of early parenteral compared to delayed enteral nutrition. Intensive Care Med. 2013;39(5):981–2.

    Article  PubMed  Google Scholar 

  39. Falzone E, Hoffmann C, Keita H. Postoperative analgesia in elderly patients. Drugs Aging. 2013;30(2):81–90.

    Article  CAS  PubMed  Google Scholar 

  40. Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother. 2007;5(3):263–303.

    Article  CAS  PubMed  Google Scholar 

  41. Mann C, Pouzeratte Y, Boccara G, et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology. 2000;92(2):433–41.

    Article  CAS  PubMed  Google Scholar 

  42. Rich MW. Epidemiology, clinical features, and prognosis of acute myocardial infarction in the elderly. Am J Geriatr Cardiol. 2006;15(1):7–11. quiz 12.

    Article  PubMed  Google Scholar 

  43. Gregoratos G. Clinical manifestations of acute myocardial infarction in older patients. Am J Geriatr Cardiol. 2001;10(6):345–7.

    Article  CAS  PubMed  Google Scholar 

  44. Kannel WB, Dannenberg AL, Abbott RD. Unrecognized myocardial infarction and hypertension: the Framingham study. Am Heart J. 1985;109(3 Pt 1):581–5.

    Article  CAS  PubMed  Google Scholar 

  45. Wadke R. Atrial fibrillation. Dis Mon. 2013;59(3):67–73.

    Article  PubMed  Google Scholar 

  46. Nantsupawat T, Nugent K, Phrommintikul A. Atrial fibrillation in the elderly. Drugs Aging. 2013;30(8):593–601.

    Article  CAS  PubMed  Google Scholar 

  47. Aronow WS. Atrial fibrillation. Heart Dis. 2002;4(2):91–101.

    PubMed  Google Scholar 

  48. Chalfin DB. Outcome assessment in elderly patients with critical illness and respiratory failure. Clin Chest Med. 1993;14(3):583–9.

    CAS  PubMed  Google Scholar 

  49. Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med. 2003;29(12):2137–43.

    Article  PubMed  Google Scholar 

  50. Heuser MD, Case LD, Ettinger WH. Mortality in intensive care patients with respiratory disease. Is age important? Arch Intern Med. 1992;152(8):1683–8.

    Article  CAS  PubMed  Google Scholar 

  51. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.

    Article  PubMed  Google Scholar 

  52. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.

    Article  CAS  PubMed  Google Scholar 

  53. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15–21.

    Article  PubMed  Google Scholar 

  54. Parrillo JE, Parker MM, Natanson C, et al. Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med. 1990;113(3):227–42.

    Article  CAS  PubMed  Google Scholar 

  55. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51(5):591–8.

    Article  PubMed  Google Scholar 

  56. Sacanella E, Perez-Castejon JM, Nicolas JM, et al. Mortality in healthy elderly patients after ICU admission. Intensive Care Med. 2009;35(3):550–5.

    Article  PubMed  Google Scholar 

  57. Teno JM, Gozalo PL, Bynum JP, et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470–7.

    Google Scholar 

  58. Hennessy D, Juzwishin K, Yergens D, Noseworthy T, Doig C. Outcomes of elderly survivors of intensive care: a review of the literature. Chest. 2005;127(5):1764–74.

    Article  PubMed  Google Scholar 

  59. Stapleton RD, Engelberg RA, Wenrich MD, Goss CH, Curtis JR. Clinician statements and family satisfaction with family conferences in the intensive care unit. Crit Care Med. 2006;34(6):1679–85.

    Article  PubMed  Google Scholar 

  60. Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5):469–78.

    Article  CAS  PubMed  Google Scholar 

  61. O’Mahony S, McHenry J, Blank AE, et al. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med. 2010;24(2):154–65.

    Article  PubMed  Google Scholar 

  62. Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med. 2007;35(6):1530–5.

    Article  PubMed  Google Scholar 

  63. Campbell ML, Guzman JA. Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest. 2003;123(1):266–71.

    Article  PubMed  Google Scholar 

  64. Nelson JE, Mulkerin CM, Adams LL, Pronovost PJ. Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback. Qual Saf Health Care. 2006;15(4):264–71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Jefferson Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 702, Philadelphia, PA, 19107, USA

    David W. Rittenhouse M.D.

  2. Traumatology, Surgical Critical Care and Emergency Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 Maloney, Philadelphia, PA, 19104, USA

    Niels D. Martin M.D., F.A.C.S.

  3. Division of Acute Care, Department of Surgery, Jefferson Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 702, Philadelphia, PA, 19107, USA

    Michael S. Weinstein M.D., F.A.C.S.

Authors
  1. David W. Rittenhouse M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niels D. Martin M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael S. Weinstein M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David W. Rittenhouse M.D. .

Editor information

Editors and Affiliations

  1. Department of Urology and the Landon Center on Aging, The University of Kansas, Kansas City, Kansas, USA

    Tomas Lindor Griebling

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Rittenhouse, D.W., Martin, N.D., Weinstein, M.S. (2014). Critical Care in Older Adults. In: Griebling, T. (eds) Geriatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9047-0_29

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-9047-0_29

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-9046-3

  • Online ISBN: 978-1-4614-9047-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation