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Review
. 2023 Jan 22:18:93-112.
doi: 10.2147/CIA.S365968. eCollection 2023.

Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges

Lucille B Brunker  1 , Christina S Boncyk  1   2 , Kimberly F Rengel  1   2 , Christopher G Hughes  1   2
Affiliations
Review

Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges

Lucille B Brunker et al. Clin Interv Aging. .

Abstract

There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.

Keywords: critical illness; geriatric syndrome; organ dysfunction; respiratory failure; shock.

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Conflict of interest statement

CSB and CGH are consultants for and received fees from Sedana Medical. CGH has received research grant funding from Kohler Chemie. The authors declare no other competing interests for this work.

Figures

Figure 1
Figure 1
System-specific considerations for the critically Ill older adult patient. Age-related changes to the central nervous, cardiovascular, respiratory, musculoskeletal, renal, and immune systems are highlighted. Together these changes can impact overall patient health at baseline, and may be of particular concern during acute illness when physiologic homeostasis is particularly altered. Consideration of these changes should be made by all clinicians caring for older adults to help guide clinical decision making, family discussions, and overall goals of care. Image is powered by Piktochart.
Figure 2
Figure 2
Conditions and concerns for older adults admitted to the intensive care unit. Older adults admitted to the intensive care unit present with a unique constellation of physiologic effects of aging that should be considered. In addition to their acute illness, baseline frailty/functional status, and geriatric syndromes/multimorbidities greatly impact outcomes. Additional influences that must be considered by the clinician includes presenting or iatrogenic polypharmacy and malnutrition as pose as potentially modifiable clinical factors. Physiologic conditions including cognitive impairment, alterations in metabolism, decreased muscle mass, immunosenescence, cardiac reserve, and an increased risk of lung injury are all common among older adults. Image is powered by Piktochart.
See this image and copyright information in PMC

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