Intensive Care of Geriatric Patients-a thin Line Between Under- and Overtreatment

Overview

Journal Wien Med Wochenschr

Specialty General Medicine

Date 2022 Jan 10

PMID 35006520

Authors

Hans Jurgen Heppner

Hag Haitham

Affiliations

Soon will be listed here.

Abstract

Demographic developments are leading to an ever-increasing proportion of elderly and aged patients in hospitals at all levels of care, and even more patients from these age groups are to be expected in the future. Based on the projected population development, e.g., in Norway, an increase in intensive care beds of between 26 and 37% is expected by 2025. This poses special challenges for the treatment and management of geriatric intensive care patients. The acute illness is not the only decisive factor, but rather the existing multimorbidity and functional limitations of this vulnerable patient group must likewise be taken into account. Age per se is not the sole determinant of prognosis in critical patients, even though mortality increases with age.

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References

Singler K, Christ M, Sieber C, Gosch M, Heppner H . [Geriatric patients in emergency and intensive care medicine]. Internist (Berl). 2011; 52(8):934-8. DOI: 10.1007/s00108-011-2804-9. View

Law A, Turnbull A . Patient-Centered Outcomes After Sepsis: Disentangling Mind and Matter. Chest. 2020; 158(5):1808-1809. DOI: 10.1016/j.chest.2020.07.049. View

Grenness C, Meyer C, Scarinci N, Ekberg K, Hickson L . The International Classification of Functioning, Disability and Health as a Framework for Providing Patient- and Family-Centered Audiological Care for Older Adults and Their Significant Others. Semin Hear. 2016; 37(3):187-99. PMC: 4954784. DOI: 10.1055/s-0036-1584411. View

Grossmann F, Zumbrunn T, Frauchiger A, Delport K, Bingisser R, Nickel C . At risk of undertriage? Testing the performance and accuracy of the emergency severity index in older emergency department patients. Ann Emerg Med. 2012; 60(3):317-25.e3. DOI: 10.1016/j.annemergmed.2011.12.013. View

Dumot J, Burval D, Sprung J, Waters J, Mraovic B, Karafa M . Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of "limited" resuscitations. Arch Intern Med. 2001; 161(14):1751-8. DOI: 10.1001/archinte.161.14.1751. View

Lerolle N, Trinquart L, Bornstain C, Tadie J, Imbert A, Diehl J . Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med. 2009; 38(1):59-64. DOI: 10.1097/CCM.0b013e3181b088ec. View

Sprung C, Baras M, Iapichino G, Kesecioglu J, Lippert A, Hargreaves C . The Eldicus prospective, observational study of triage decision making in European intensive care units: part I--European Intensive Care Admission Triage Scores. Crit Care Med. 2011; 40(1):125-31. DOI: 10.1097/CCM.0b013e31822e5692. View

Sprung C, Artigas A, Kesecioglu J, Pezzi A, Wiis J, Pirracchio R . The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly. Crit Care Med. 2011; 40(1):132-8. DOI: 10.1097/CCM.0b013e318232d6b0. View

Jung C, Bruno R, Wernly B, Wolff G, Beil M, Kelm M . Frailty as a Prognostic Indicator in Intensive Care. Dtsch Arztebl Int. 2020; 117(40):668-673. PMC: 7838379. DOI: 10.3238/arztebl.2020.0668. View

10.

Heriot N, Levinson M, Mills A, Khine T, Gellie A, Sritharan G . Diagnosing delirium in very elderly intensive care patients. Intensive Crit Care Nurs. 2016; 38:10-17. DOI: 10.1016/j.iccn.2016.07.002. View

11.

Steinman M, Lee S, Boscardin W, Miao Y, Fung K, Moore K . Patterns of multimorbidity in elderly veterans. J Am Geriatr Soc. 2012; 60(10):1872-80. PMC: 4133992. DOI: 10.1111/j.1532-5415.2012.04158.x. View

12.

Heppner H, Bauer J, Sieber C, Bertsch T . Laboratory aspects relating to the detection and prevention of frailty. Int J Prev Med. 2011; 1(3):149-57. PMC: 3075524. View

13.

Hifumi T, Jinbo I, Okada I, Kiriu N, Kato H, Koido Y . The impact of age on outcomes of elderly ED patients ventilated due to community acquired pneumonia. Am J Emerg Med. 2014; 33(2):277-81. DOI: 10.1016/j.ajem.2014.10.046. View

14.

LaMantia M, Platts-Mills T, Biese K, Khandelwal C, Forbach C, Cairns C . Predicting hospital admission and returns to the emergency department for elderly patients. Acad Emerg Med. 2010; 17(3):252-9. PMC: 5985811. DOI: 10.1111/j.1553-2712.2009.00675.x. View

15.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

16.

Wehler M . [Long-term outcome of elderly patients after intensive care treatment]. Med Klin Intensivmed Notfmed. 2011; 106(1):29-33. DOI: 10.1007/s00063-011-0021-x. View

17.

Vosylius S, Sipylaite J, Ivaskevicius J . Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing. 2005; 34(2):157-62. DOI: 10.1093/ageing/afi037. View

18.

Thiem U, Niklaus D, Sehlhoff B, Stuckle C, Heppner H, Endres H . C-reactive protein, severity of pneumonia and mortality in elderly, hospitalised patients with community-acquired pneumonia. Age Ageing. 2009; 38(6):693-7. DOI: 10.1093/ageing/afp164. View

19.

Meurer W, Losman E, Smith B, Malani P, Younger J . Short-term functional decline of older adults admitted for suspected sepsis. Am J Emerg Med. 2010; 29(8):936-42. DOI: 10.1016/j.ajem.2010.04.003. View

20.

Mankowski R, Anton S, Ghita G, Brumback B, Cox M, Mohr A . Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long-Term Survival. J Am Geriatr Soc. 2020; 68(9):1962-1969. PMC: 7654284. DOI: 10.1111/jgs.16435. View