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

Abstract

The "very old intensive care patients" (abbreviated to VOPs; greater than 80 years old) are probably the fastest expanding subgroup of all intensive care unit (ICU) patients. Up until recently most ICU physicians have been reluctant to admit these VOPs. The general consensus was that there was little survival to gain and the incremental life expectancy of ICU admission was considered too small. Several publications have questioned this belief, but others have confirmed the poor long-term mortality rates in VOPs. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making and improved prediction models are also needed for this particular patient group. Here, an expert panel proposes a research agenda for VOPs for the coming years.

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU

“…More than 10% of the patients admitted to the intensive care unit (ICU) are 80 years and older . This proportion of “very old intensive care patients” (VIPs) is estimated to increase up to 36% in 2025 .…”

“…Most intensivists estimate a patient's chances of outcome on experience and on preferences. Current severity scoring systems are not tailored for VIPs, and proposed models for VIP are not precise enough …”

Focus on infection and sepsis 2017

“…In a recent observational multicenter study with almost 3000 patients with severe CAP, older patients more often had co-infection when infected by influenza, and co-infection was independently associated with higher mortality [12]. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making, and improved prediction models should be incorporated in aging populations [13].…”

The Baby Boom and later life: is critical care fit for the future?

“…Interestingly, although critical care outcomes are generally improving amongst the elderly, resource limitations will almost certainly play a role, and there is likely to be variation in triage criteria applied to certain patient groups before admittance to the ICU [10]. It is clear that on the societal level, admission of elderly patients to the ICU provides diminishing return (from 22 QALYs in those under 65 years old to 4.1 QALYs to those over 80 years old) but also that chronological age is too crude a criterion by which to select ICU candidates [11].…”

“…Recently, Flaatten et al [10] compiled a list of ten important critical care trials urgently needed in this field. Thus, the need for greater epidemiological understanding, the lack of objective assessment tools for prognosticating in this group and, possibly most importantly, the lack of understanding on how patients and relatives would view the prospect of ICU admission and the resulting burden, underline the fundamental issues facing our specialisation [10].…”