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Review
, 8 (1), 114

Caring for the Critically Ill Patients Over 80: A Narrative Review

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Review

Caring for the Critically Ill Patients Over 80: A Narrative Review

Bertrand Guidet et al. Ann Intensive Care.

Abstract

Background: There is currently no international recommendation for the admission or treatment of the critically ill older patients over 80 years of age in the intensive care unit (ICU), and there is no valid prognostic severity score that includes specific geriatric assessments.

Main body: In this review, we report recent literature focusing on older critically ill patients in order to help physicians in the multiple-step decision-making process. It is unclear under what conditions older patients may benefit from ICU admission. Consequently, there is a wide variation in triage practices, treatment intensity levels, end-of-life practices, discharge practices and frequency of geriatrician's involvement among institutions and clinicians. In this review, we discuss important steps in caring for critically ill older patients, from the triage to long-term outcome, with a focus on specific conditions in the very old patients.

Conclusion: According to previous considerations, we provide an algorithm presented as a guide to aid in the decision-making process for the caring of the critically ill older patients.

Figures

Fig. 1
Fig. 1
Algorithm for critically ill patients over 80y
Fig. 2
Fig. 2
Impact of acute stress on fit or frail elderly. Physiological aging, comorbidities and functional dependency are the main components of frailty syndrome, leading to decrease in reserve capacities. At baseline, impact of frailty on survival is slight but its weight dramatically grows in case of acute stress (all medical events leading to ICU admission) and increase the risk of death comparatively to the fit elderly
Fig. 3
Fig. 3
Mortality. a Represents mortality rates in critically ill elderly patients following admission to the ICU at ICU and hospital discharge, at 30-day and 3, 6, 12 and 24 months in single-center studies from 2000 to 2017. b Represents mortality rates in critically ill elderly patients following admission to the ICU at ICU and hospital discharge, at 30-day and 3, 6, 12 and 24 months in multicenter studies from 2012 to 2017

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