[Resuscitation in the elderly: prognostic factors]

Abstract

High medical environment in our society is linked up with an increase of intensive care in geriatric patients. Such a situation can seem to be inappropriate, especially when it results in a trial to obtain the survival of patients who are finishing their life. Therefore an appropriate medical evaluation and management are required in order to quantify as fairly as possible both prognosis and specific risks. Mortality factors in elderly patients are multiple and additive. Two groups of risks can be distinguished: intrinsic risk factors depending on the patient (age, neurologic impairment, severity of acute illness, previous health status), and extrinsic risk factors, related to medical environment (i.e. length of stay in intensive care unit, care quality...). These latter are improvable. In the elderly, the mortality rate is twofold higher (about 35%) than in young patients. Evaluation of intensive care unit outcome on 6 month survival makes this rate worse, as 10% to 20% more patients die secondarily. However, most of the studies demonstrate that duration of stay in intensive care units is similar, whatever the age and outcome. It must also be underlined that quality of life after intensive care is similar in young and old patients. It is concluded that individual's and society's views concerning cost and effectiveness of intensive care in elderly patients do not always coincide with objective results. If medical motivation has to be preserved, specific care strategy remains to be established.