Primary assessment and stabilization of life-threatening conditions in older patients

Abstract

Although the main approach to life-threatening conditions in older patients does not differ from younger adults, the evaluation of the severity and the decision to start resuscitation are much more challenging. The clinical presentation of instability and life-threatening situations is often atypical in older patients. When the instability and severity are confirmed, the classical chain of basic and advanced life support recommended by the European and international guidelines must be respected for improving outcomes in older patients. The decision of stopping or not starting resuscitation in older patients should not be taken too quickly just because it is thought that it can appear futile or of a result of advanced age. The decision depends also on patients’ and relatives’ wishes and respects individual patient’s needs for end-of-life care. As in younger people, resuscitation in older patients is appropriate when its likely benefits in term of quantity and quality of life outweigh over its adverse consequences. This is especially important for older patients in continuing care settings, which might potentially divert staff time and resources away from core elements of care. During the primary assessment and stabilization of life-threatening conditions, lifesaving procedures must be instituted considering that diagnostic and management procedures should be performed simultaneously and continuously, which needs a systematic approach.