On the Benefit of Intensive Care for Very Old Patients

Cardiovascular profile in critically ill elderly medical patients: Prevalence, mortality and length of stay

“…To our knowledge, no studies have determined the prevalence of baseline cardiovascular treatment in the elderly (≥ 80 years-old) admitted to the ICU. Prevalence of ICU mortality, in-hospital mortality and 1-year mortality was in agreement with previously published literature, where results vary between 19.5%-47% [22,[24][25][26], 33%-55% [3,22,27] and 48%-67% [24,28] respectively. The medians of ICU and hospital length of stay were in the range reported in other series [6,29,30].…”

The status of intensive care medicine research and a future agenda for very old patients in the ICU

“…Short-term survival may clearly benefit from ICU treatment but 1-year mortality is very high. There are indications that the incremental mortality benefit of very old patients admitted to the ICU is not substantial [4]. If other important outcomes are considered (functional outcome and quality of life) the beneficial outcome from intensive care therapy is even less certain.…”

“…In the large Eldicus study the elderly patients (greater than 75 years old) were found to have more ICU rejections than younger ones (less than 75 years old) despite having a greater mortality benefit [3]. On the other hand, in a prospective French study, no survival benefit was found in VOPs who were admitted versus rejected patients [4]. The imminent increase in the number of VOPs will likely increase the need for triage even further as it seems unlikely there will be a significant growth of ICU bed numbers in Europe.…”

The challenge of admitting the very elderly to intensive care

“…To date, there is no randomized, controlled study available; the only available data came from observational studies with inherent limitations (retrospective collection of data at baseline, lack of a control group). Boumendil et al recently reported in a multicenter observational study (including a majority of medical admissions) that ICU admission compared with admission to a regular ward did not improve the long-term survival of patients aged 80 years and older [30]. These results emphasized previous data of Martínez-Sellés et al who reported that the outcome of persons aged 90 years and older admitted with acute myocardial infarction was not influenced by an admission to a coronary care unit [31].…”