Geriatric critical care: the elderly ICU patient

Also known as Elderly ICU · Geriatric ICU · Frailty in ICU · Older critical care patient · Age and critical illness

Geriatric critical care: patients aged 65-80 in ICU. Physiological changes of ageing: reduced organ reserve (cardiac, renal, respiratory), altered pharmacokinetics (decreased renal clearance, increased body fat, decreased albumin), polypharmacy, frailty, comorbidities. Key principles: (1) FRAILTY (not age alone) predicts outcomes better than chronological age. (2) Polypharmacy — review all medications, deprescribe. (3) Delirium — extremely common in elderly ICU, worsens outcomes. (4) Iatrogenic complications (infections, bleeding, falls). (5) Goals of care discussions — realistic prognosis, quality of life. (6) Early mobilisation — prevents deconditioning. (7) Nutrition — sarcopenia. Outcomes: higher mortality, longer recovery, more disability…

medium24 referencesUpdated 19 Aug 202625 min readVerification in progress

Practise this topic

3 MCQs

Meet the patient

An 82-year-old woman with urosepsis, on a walking frame before admission, needing help with shopping and her finances. She is septic on noradrenaline, her creatinine is 230, and the registrar asks how you will explain her prognosis. The first move is not a number on a score — it is a telephone call to her daughter for the two weeks before this illness.^[1]

The single question that reframes geriatric critical care is this: how was she before? Chronological age is a poor predictor; the pre-morbid baseline — captured in one minute by the Clinical Frailty Scale — is the variable that actually forecasts who lives, who goes home, and who never does.^[1]

ICU management of the elderly patient — the geriatric bundle

Assess frailty — Clinical Frailty Scale (1-9). Frailty (at least 5) is independently associated with ICU mortality after adjustment for age, sex and illness acuity, and with institutionalisation after critical illness.^[6]
Medication review — reconcile, deprescribe, adjust doses for renal and hepatic function, screen for potentially inappropriate medications (Beers), cut polypharmacy: medication stewardship reduces medication-related harm in older ICU patients.^[23]^[16]
Prevent delirium — assess and manage pain, target light sedation, protect the sleep-wake cycle, orient, family at the bedside, glasses and hearing aids, mobilise early, avoid restraints.^[9]^[11]
Mobilise early — progress mobility daily; complete ABCDEF bundle performance is associated with less delirium, coma, physical restraint use and next-day mechanical ventilation.^[19]
Nutrition — assess for sarcopenia and malnutrition risk, feed enterally, meet protein targets while advancing calories gradually in the first days.^[21]^[22]
Goals of care — realistic prognosis, quality of life, advance care planning, involve family, consider palliative care, respect advance directives.^[7]
Plan discharge and survivorship — rehabilitation, community support, ICU follow-up; plan for post-intensive care syndrome (cognitive, physical, psychological).^[3]^[5]

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References24Show

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