Critical Care in the Elderly: The Final Challenge

Abstract

Critical care for the elderly is an important issue for at least two reasons. First, as the population ages more elderly critically ill patients will present to intensive care units (ICUs). Second, health care expenditure cannot increase in an uncontrolled manner; some form of control or rationing is inevitable. The elderly are becoming increasingly numerous; in 1990, patients aged more than 65 years made up 12.6% of the population in the USA and are projected to reach 22% by 2030 [1]. In the UK, the Intensive Care Society’s UK APACHE II study performed in the late eighties reported that the average age of almost 10000 critically ill patients was 56.3 years [2]. Since then, the average age of adult critically ill patients has increased by 1 year each year so testifying to the effect of shifting population demographics [3]. Elderly patients tend (and the emphasis is tend) to survive less well than younger patients. For example, van der Sluis et al. [4] have shown how the mortality of patients aged over 60 years is almost twice as high as that of 20 to 29 year olds over the Injury Severity Score range 16 to 75. In a review, Chelluri et al. [5] reported that the 1 year mortality of elderly patients following critical illness varied between 27% and 64% which is considerably higher than younger patients.