Management of the critically ill geriatric patient

Abstract

Population aging is accelerating rapidly worldwide with increasing numbers of elderly patients being admitted to ICUs. In the USA elderly patients currently account for 42-52 % of ICU admissions and for almost 60 % of all ICU days. With the aging of the population the demand for ICU beds is likely to increase. It is therefore appropriate to determine which elderly patients are likely to benefit from admission to the ICU. An analysis of the available data suggests that functional elderly patients have a favorable long-term outcome following ICU admission and that age alone should not be used in making ICU triage decisions. The decision to admit an elderly patient to an ICU should be based upon the patient’s comorbidities, acuity of illness, and pre-hospital functional status. However, elderly patients who may require prolonged mechanical ventilation appear to do poorly and a time limited trial in the ICU may be appropriate in such patients. The operative mortality and incidence of postoperative complications are increased in elderly patients undergoing surgery. Surgery should therefore be considered very carefully in the elderly. This chapter reviews the physiology of aging as it applies to critical illness, the outcome of elderly patients admitted to the ICU as well as specific issues as they apply to the elderly ICU patient.