Elderly patients and intensive care medicine

Excerpt

Global population aging is a process known as the “demographic transition” in which mortality and fertility decrease. Fertility decline has been the primary determinant of population aging, but mortality decline, especially at older ages, plays an increasingly important role. Chances of surviving to old age have improved, causing relative increases in the older population: its size growing by 2% each year, considerably faster than the population as a whole. For at least the next 25 years the older population is expected to continue growing more rapidly than other age groups [1]. As a result hospitalizations for acute illness in the elderly population will increase. As many other medical units, intensive care units (ICUs) are facing an increasing demand for care from older individuals. Clinicians are sometimes reluctant to provide intensive care to older individuals in times of limited financial resources. As shown by three contributions originating from The Netherlands [2], Spain [3], and France [4] presently appearing in Intensive Care Medicine, elderly patients in ICUs are a major concern and clearly a matter of debate in Europe. One can differentiate three topics in the rather broad subject area of elderly patients in the ICU: the decision to admit or refuse the patient (referred to as triage), intensive care unit stay characteristics (length of stay, workload, and discharge modalities), and long-term outcome following intensive care (mortality, quality of life, autonomy). …