Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Annals of Intensive Care
Published in: Annals of Intensive Care 1/2024

Open Access 01-12-2024 | Geriatric Assessment | Review

Critical care beyond organ support: the importance of geriatric rehabilitation

Authors: Jeremy M. Jacobs, Ana Rahamim, Michael Beil, Bertrand Guidet, Helene Vallet, Hans Flaatten, Susannah K. Leaver, Dylan de Lange, Wojciech Szczeklik, Christian Jung, Sigal Sviri

Published in: Annals of Intensive Care | Issue 1/2024

Login to get access

Abstract

Very old critically ill patients pose a growing challenge for intensive care. Critical illness and the burden of treatment in the intensive care unit (ICU) can lead to a long-lasting decline of functional and cognitive abilities, especially in very old patients. Multi-complexity and increased vulnerability to stress in these patients may lead to new and worsening disabilities, requiring careful assessment, prevention and rehabilitation. The potential for rehabilitation, which is crucial for optimal functional outcomes, requires a systematic, multi-disciplinary approach and careful long-term planning during and following ICU care. We describe this process and provide recommendations and checklists for comprehensive and timely assessments in the context of transitioning patients from ICU to post-ICU and acute hospital care, and review the barriers to the provision of good functional outcomes.
Appendix
Available only for authorised users
Literature
1.
2.
Herridge MS, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, et al. The RECOVER Program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Am J Respir Crit Care Med. 2016;194(7):831–44.PubMedCrossRef
3.
4.
Watanabe S, Hirasawa J, Naito Y, Mizutani M, Uemura A, Nishimura S, et al. Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge. Sci Rep. 2023;13(1):4265.PubMedPubMedCentralCrossRef
5.
Taylor RS, Dalal HM, Zwisler AD. Cardiac rehabilitation for heart failure: “Cinderella” or evidence-based pillar of care? Eur Heart J. 2023;44(17):1511–8.PubMedPubMedCentralCrossRef
6.
7.
Reid A, Young P. What intensivists can learn from geriatric medicine. ICU Manag Pract. 2020;20(3):195–7.
8.
Woodbridge HR, Norton C, Jones M, Brett SJ, Alexander CM, Gordon AC. Clinician and patient perspectives on the barriers and facilitators to physical rehabilitation in intensive care: a qualitative interview study. BMJ Open. 2023;13(11): e073061.PubMedPubMedCentralCrossRef
9.
Beil M, Flaatten H, Guidet B, Sviri S, Jung C, de Lange D, et al. The management of multi-morbidity in elderly patients: ready yet for precision medicine in intensive care? Crit Care. 2021;25(1):330.PubMedPubMedCentralCrossRef
10.
World Health Organization. Rehabilitation: key for health in the 21st century. Geneva: Switzerland, World Health Organization; 2017.
11.
World Health Organization. The international classification of functioning, disability and health. Geneva: World Health Organization; 2001.
12.
Beard JR, Jotheeswaran AT, Cesari M, Araujo de Carvalho I. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. BMJ Open. 2019;9(11): e026119.PubMedPubMedCentralCrossRef
13.
Mitnitski AB, Rutenberg AD, Farrell S, Rockwood K. Aging, frailty and complex networks. Biogerontology. 2017;18(4):433–46.PubMedCrossRef
14.
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.PubMedCrossRef
15.
Howlett SE, Rutenberg AD, Rockwood K. The degree of frailty as a translational measure of health in aging. Nat Aging. 2021;1(8):651–65.PubMedCrossRef
16.
Mitnitski A, Howlett SE, Rockwood K. Heterogeneity of human aging and its assessment. J Gerontol A Biol Sci Med Sci. 2017;72(7):877–84.PubMed
17.
Wernly B, Bruno RR, Beil M, Flaatten H, Kelm M, Sigal S, et al. Frailty’s influence on 30-day mortality in old critically ill ICU patients: a Bayesian analysis evaluating the clinical frailty scale. Ann Intensive Care. 2023;13(1):126.PubMedPubMedCentralCrossRef
18.
Beil M, van Heerden PV, de Lange DW, Szczeklik W, Leaver S, Guidet B, et al. Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care. BMC Med Inform Decis Mak. 2023;23(1):1.PubMedPubMedCentralCrossRef
19.
Jung C, Guidet B, Flaatten H. Frailty in intensive care medicine must be measured, interpreted and taken into account! Intensive Care Med. 2023;49(1):87–90.PubMedCrossRef
20.
Bassford C, Griffiths F, Svantesson M, Ryan M, Krucien N, Dale J, et al. Developing an intervention around referral and admissions to intensive care: a mixed-methods study. Health Serv Deliv Res. 2019;7(39):1–284.CrossRef
21.
Bruno RR, Wernly B, Bagshaw SM, van den Boogaard M, Darvall JN, De Geer L, et al. The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data. Ann Intensive Care. 2023;13(1):37.PubMedPubMedCentralCrossRef
22.
Mousai O, Tafoureau L, Yovell T, Flaatten H, Guidet B, Jung C, et al. Clustering analysis of geriatric and acute characteristics in a cohort of very old patients on admission to ICU. Intensive Care Med. 2022;48(12):1726–35.PubMedPubMedCentralCrossRef
23.
Beil M, van Heerden PV, Joynt GM, Lapinsky S, Flaatten H, Guidet B, et al. Limiting life-sustaining treatment for very old ICU patients: cultural challenges and diverse practices. Ann Intensive Care. 2023;13(1):107.PubMedPubMedCentralCrossRef
24.
Vink EE, Azoulay E, Caplan A, Kompanje EJO, Bakker J. Time-limited trial of intensive care treatment: an overview of current literature. Intensive Care Med. 2018;44(9):1369–77.PubMedCrossRef
25.
Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, et al. What is Comprehensive Geriatric Assessment (CGA)? An umbrella review. Age Ageing. 2018;47(1):149–55.PubMedCrossRef
26.
Wissanji T, Forget MF, Muscedere J, Beaudin D, Coveney R, Wang HT. Models of care in geriatric intensive care-a scoping review on the optimal structure of care for critically ill older adults admitted in an ICU. Crit Care Explor. 2022;4(4): e0661.PubMedPubMedCentralCrossRef
27.
Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017;9(9): Cd006211.PubMed
28.
Tinetti M, Huang A, Molnar F. The Geriatrics 5M’s: a new way of communicating what we do. J Am Geriatr Soc. 2017;65(9):2115.PubMedCrossRef
29.
Lucke JA, Mooijaart SP, Heeren P, Singler K, McNamara R, Gilbert T, et al. Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine. Eur Geriatr Med. 2022;13(2):309–17.PubMedCrossRef
30.
Yogaparan T, Burrell A, Talbot-Hamon C, Sadowski CA, Grief C, MacDonald E, et al. The aging care 5Ms competencies: a modified Delphi study to revise medical student competencies for the care of older adults. Acad Med. 2023;99:198–207.PubMedCrossRef
31.
Pietiläinen L, Hästbacka J, Bäcklund M, Parviainen I, Pettilä V, Reinikainen M. Premorbid functional status as a predictor of 1-year mortality and functional status in intensive care patients aged 80 years or older. Intensive Care Med. 2018;44(8):1221–9.PubMedCrossRef
32.
Heyland DK, Stelfox HT, Garland A, Cook D, Dodek P, Kutsogiannis J, et al. Predicting performance status 1 year after critical illness in patients 80 years or older: development of a multivariable clinical prediction model. Crit Care Med. 2016;44(9):1718–26.PubMedCrossRef
33.
Beil M, Flaatten H, Guidet B, Joskowicz L, Jung C, de Lange D, et al. Time-dependent uncertainty of critical care transitions in very old patients - lessons for time-limited trials. J Crit Care. 2022;71: 154067.PubMedCrossRef
34.
Guidet B, Vallet H, Flaatten H, Joynt G, Bagshaw SM, Leaver SK, et al. The trajectory of very old critically ill patients. Intensive Care Med. 2024;50:181–94.PubMedCrossRef
35.
Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR, et al. Decision making for older adults with multiple chronic conditions: executive summary for the American Geriatrics Society guiding principles on the care of older adults with multimorbidity. J Am Geriatr Soc. 2019;67(4):665–73.PubMedCrossRef
36.
Sloane PD. The geriatric-focused emergency department: opportunities and challenges. J Am Med Dir Assoc. 2022;23(8):1288–90.PubMedCrossRef
37.
38.
Jain S, Murphy TE, O’Leary JR, Leo-Summers L, Ferrante LE. Association between socioeconomic disadvantage and decline in function, cognition, and mental health after critical illness among older adults: a cohort study. Ann Intern Med. 2022;175(5):644–55.PubMedPubMedCentralCrossRef
39.
Mansbach WE, MacDougall EE, Clark KM, Mace RA. Preliminary investigation of the Kitchen Picture Test (KPT): a new screening test of practical judgment for older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2014;21(6):674–92.PubMedCrossRef
40.
American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052–81.
41.
O’Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023;14(4):625–32.PubMedPubMedCentralCrossRef
42.
Lospitao-Gómez S, Sebastián-Viana T, González-Ruíz JM, Álvarez-Rodríguez J. Validity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI) and the Norton-MI scale in critically ill patients. Appl Nurs Res. 2017;38:76–82.PubMedCrossRef
43.
44.
Brummel NE, Bell SP, Girard TD, Pandharipande PP, Jackson JC, Morandi A, et al. Frailty and subsequent disability and mortality among patients with critical illness. Am J Respir Crit Care Med. 2017;196(1):64–72.PubMedPubMedCentralCrossRef
45.
Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med. 2017;43(12):1820–8.PubMedCrossRef
46.
Guidet B, de Lange DW, Boumendil A, Leaver S, Watson X, Boulanger C, et al. The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study. Intensive Care Med. 2020;46(1):57–69.PubMedCrossRef
47.
Haas LEM, Boumendil A, Flaatten H, Guidet B, Ibarz M, Jung C, et al. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age Ageing. 2021;50(5):1719–27.PubMedCrossRef
48.
Fuest KE, Ulm B, Daum N, Lindholz M, Lorenz M, Blobner K, et al. Clustering of critically ill patients using an individualized learning approach enables dose optimization of mobilization in the ICU. Crit Care. 2023;27(1):1.PubMedPubMedCentralCrossRef
49.
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.PubMedCrossRef
50.
Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Executive summary: clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):1532–48.PubMedCrossRef
51.
Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825–73.PubMedCrossRef
52.
Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, et al. Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med. 2019;47(1):3–14.PubMedPubMedCentralCrossRef
53.
Goldfarb M, Semsar-Kazerooni K, Morais JA, Dima D. Early mobilization in older adults with acute cardiovascular disease. Age Ageing. 2021;50(4):1166–72.PubMedCrossRef
54.
Parco C, Kreuels V, Kelm M, Jung C, Wolff G. Robotic-assisted early mobilization and virtual reality: a perspective on innovative support strategies for critically ill patients. Intensive Care Med Exp. 2023;11(1):86.PubMedPubMedCentralCrossRef
55.
Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000;118(6):1801–13.PubMedCrossRef
56.
Twose P, Jones U, Cornell G. Minimum standards of clinical practice for physiotherapists working in critical care settings in the United Kingdom: a modified Delphi technique. J Intensive Care Soc. 2019;20(2):118–31.PubMedCrossRef
57.
Takahashi T, Kato M, Obata K, Kozu R, Fujimoto T, Yamashita K, et al. Minimum standards of clinical practice for physical therapists working in intensive care units in Japan. Phys Ther Res. 2021;24(1):52–68.PubMedCrossRef
58.
Jenkins AS, Isha S, Hanson AJ, Kunze KL, Johnson PW, Sura L, et al. Rehabilitation in the intensive care unit: how amount of physical and occupational therapy impacts patients’ functionality and length of hospital stay. Pm R. 2023;16(219):225.
59.
Costigan FA, Duffett M, Harris JE, Baptiste S, Kho ME. Occupational therapy in the ICU: a scoping review of 221 documents. Crit Care Med. 2019;47(12):e1014–21.PubMedCrossRef
60.
Gomes TT, Schujmann DS, Fu C. Rehabilitation through virtual reality: physical activity of patients admitted to the intensive care unit. Rev Bras Ter Intensiva. 2019;31(4):456–63.PubMedPubMedCentralCrossRef
61.
Naef AC, Jeitziner MM, Gerber SM, Jenni-Moser B, Müri RM, Jakob SM, et al. Virtual reality stimulation to reduce the incidence of delirium in critically ill patients: study protocol for a randomized clinical trial. Trials. 2021;22(1):174.PubMedPubMedCentralCrossRef
62.
Dirkes SM, Kozlowski C. Early mobility in the intensive care unit: evidence, barriers, and future directions. Crit Care Nurse. 2019;39(3):33–42.PubMedCrossRef
63.
Nydahl P, Jeitziner MM, Vater V, Sivarajah S, Howroyd F, McWilliams D, et al. Early mobilisation for prevention and treatment of delirium in critically ill patients: systematic review and meta-analysis. Intensive Crit Care Nurs. 2023;74: 103334.PubMedCrossRef
64.
65.
Puntillo K, Nelson JE, Weissman D, Curtis R, Weiss S, Frontera J, et al. Palliative care in the ICU: relief of pain, dyspnea, and thirst–a report from the IPAL-ICU Advisory Board. Intensive Care Med. 2014;40(2):235–48.PubMedCrossRef
66.
Voiriot G, Oualha M, Pierre A, Salmon-Gandonnière C, Gaudet A, Jouan Y, et al. Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges. Ann Intensive Care. 2022;12(1):58.PubMedPubMedCentralCrossRef
67.
Nakanishi N, Liu K, Hatakeyama J, Kawauchi A, Yoshida M, Sumita H, et al. Post-intensive care syndrome follow-up system after hospital discharge: a narrative review. J Intensive Care. 2024;12(1):2.PubMedPubMedCentralCrossRef
68.
Renner C, Jeitziner MM, Albert M, Brinkmann S, Diserens K, Dzialowski I, et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care. 2023;27(1):301.PubMedPubMedCentralCrossRef
69.
Vester LB, Holm A, Dreyer P. Patients’ and relatives’ experiences of post-ICU everyday life: a qualitative study. Nurs Crit Care. 2022;27(3):392–400.PubMedCrossRef
70.
71.
72.
Azoulay E, Resche-Rigon M, Megarbane B, Reuter D, Labbé V, Cariou A, et al. Association of COVID-19 acute respiratory distress syndrome with symptoms of posttraumatic stress disorder in family members after ICU discharge. JAMA. 2022;327(11):1042–50.PubMedPubMedCentralCrossRef
73.
Connolly B, Denehy L, Hart N, Pattison N, Williamson P, Blackwood B. Physical Rehabilitation Core Outcomes In Critical illness (PRACTICE): protocol for development of a core outcome set. Trials. 2018;19(1):294.PubMedPubMedCentralCrossRef
74.
Turner-Stokes L, Corner EJ, Siegert RJ, Brown C, Wallace S, Highfield J, et al. The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I: Development and preliminary clinimetric evaluation. J Intensive Care Soc. 2022;23(3):253–63.PubMedCrossRef
75.
De Biase S, Cook L, Skelton DA, Witham M, Ten Hove R. The COVID-19 rehabilitation pandemic. Age Ageing. 2020;49(5):696–700.PubMedCrossRef
76.
Vitacca M, Barbano L, Vanoglio F, Luisa A, Bernocchi P, Giordano A, et al. Does 6-month home caregiver-supervised physiotherapy improve post-critical care outcomes?: A randomized controlled trial. Am J Phys Med Rehabil. 2016;95(8):571–9.PubMedCrossRef
77.
Werner RM, Coe NB, Qi M, Konetzka RT. Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility. JAMA Intern Med. 2019;179(5):617–23.PubMedPubMedCentralCrossRef
78.
Jacobs JM, Marcus EL, Stessman J. Prolonged mechanical ventilation: symptomatology, well-being, and attitudes to life. J Am Med Dir Assoc. 2021;22(6):1242–7.PubMedCrossRef
79.
Marcus EL, Jacobs JM, Stessman J. Prolonged mechanical ventilation and caregiver strain: Home vs. long-term care facility. Palliat Support Care. 2023;21(3):429–37.PubMedCrossRef
80.
Jacobs JM, Marcus EL, Stessman J. Prolonged mechanical ventilation: a comparison of patients treated at home compared with hospital long-term care. J Am Med Dir Assoc. 2021;22(2):418–24.PubMedCrossRef
81.
Corner EJ, Murray EJ, Brett SJ. Qualitative, grounded theory exploration of patients’ experience of early mobilisation, rehabilitation and recovery after critical illness. BMJ Open. 2019;9(2): e026348.PubMedPubMedCentralCrossRef
82.
Potter K, Miller S, Newman S. Environmental factors affecting early mobilization and physical disability post-intensive care: an integrative review through the lens of the world health organization international classification of functioning, disability, and health. Dimens Crit Care Nurs. 2021;40(2):92–117.PubMedCrossRef
83.
84.
Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502–9.PubMedCrossRef
Metadata
Title
Critical care beyond organ support: the importance of geriatric rehabilitation
Authors
Jeremy M. Jacobs
Ana Rahamim
Michael Beil
Bertrand Guidet
Helene Vallet
Hans Flaatten
Susannah K. Leaver
Dylan de Lange
Wojciech Szczeklik
Christian Jung
Sigal Sviri
Publication date
01-12-2024
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2024
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-024-01306-1

Other articles of this Issue 1/2024

Annals of Intensive Care 1/2024 Go to the issue

Review

Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review

Letter to the Editor

Challenges in investigating “Gut barrier dysfunction and bacterial translocation in ICU-acquired bacteremia”

Research

Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series

Research

Diaphragm thickness modifications and associated factors during VA-ECMO for a cardiogenic shock: a cohort study

Research

The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy

Review

Severe Legionnaires’ disease