Life-sustaining treatment limitation in intensive care for very old patients

Old patients have higher risk of death during the ICU stay, in the hospital and after discharge. When they survive, they may suffer from long-term sequel, including loss of functional autonomy and poor quality of life, and they often represent a heavy burden for the caregivers. All these factors contribute to more frequent decisions to limit and stop treatment (LST) in old patients compared to younger patients. The work-up of this decision has an impact on the ICU team and the family members. Collegiality, timing, transparency, objectivity are keys to prevent conflict, complicated griefs, and allow for the grieving process. This review explores limitation of life-sustaining treatments in the ICU: determinants, timing, impact. The shared decision-making model between the patient, his family and the healthcare team should be promoted. In a situation of prognostic uncertainty, the doubt must benefit the patient and an admission decision must be taken. After a few days, additional information could be col-lected and the evolution under treatment evaluated. During a family conference, it is decided collectively whether or not to continue active treatments. It is the concept of time-limited trial that applies particularly well to elderly patients.