Proposing a novel ABCDEF framework for managing critical illness in geriatrics: challenges and perspectives

Abstract

Background: As the global population ages rapidly, the number of older adults experiencing critical illness is increasing significantly. This growing demographic presents substantial challenges for critical care systems worldwide. However, older patients are frequently underrepresented in clinical research and often receive suboptimal care due to assumptions about low productivity, the presence of multiple comorbidities, polypharmacy, and altered physiological responses to illness and treatment. These factors contribute to a paucity of targeted studies and evidence-based guidelines for managing critical illness in geriatric populations. In contrast to younger patients, older adults often place greater emphasis on long-term outcomes and quality of life rather than survival alone. As a result, the clinical management of critical illness in this population involves distinct and complex considerations. Methods: We propose the adoption of a practical and scalable ABCDEF framework: A, Artificial Intelligence; B, Value-Based Medicine; C, Comprehensive Care Planning; D, Doctor–Patient Shared Decision-Making; E, Enhanced Recovery for Surgical and Critically Ill Patients; F, Frailty Assessment and Early Identification of High-Risk Older Adults. This framework is our core contribution, designed specifically to integrate key geriatric principles into the high-intensity setting of critical care in a structured and actionable manner. Conclusions: The ABCDEF framework offers a structured, holistic approach to geriatric critical care that improves patient-centered outcomes, optimizes resource utilization, and addresses existing gaps in research and clinical practice, ultimately enabling more compassionate, effective, and sustainable care delivery. We advocate for this framework as a proactive strategy to transform the standard of care for a growing and vulnerable patient population, moving beyond mere survival towards meaningful recovery.