Elderly patients in ICU

Due to population ageing, the number of ICU admissions of elderly people is increasing. A better understanding and comprehension of pathophysiological mechanisms involved in ageing could lead to the emergence of new therapeutics in the next few years. No consensual validated criteria exist to identify which elderly patient needs admission in ICU. Except for postoperative care after planned surgery, their mortality in ICU is higher than that of young patients. After an ICU stay, the quality of life for surviving elderly people is quite well, except for those older than 86 years. Physical activity component in outcome scales are more altered than psychological and social components. Age should not be a criterion to decide if on ICU admission is appropriate or not, even though this approach is still regularly stated in clinical studies. Frailty is far more relevant than age, comorbidities and/or usual ICU severity scores to predict physical recovery at one year. Frail patients experience poorer quality of life at 6 and 12 months compared to robust patients with more impairment in mobility, personal care, doily life activities, pain/discomfort and anxiety/depression. Frail elderly people are particularly exposed to early complications, increased risk of long-term disabilities and mortality. In-hospital mortality of frail elderly patients is 2 to 3 times higher than that of robust patients, independently of age or common severity scores used in ICU. The assessment of previous functional capabilities allows to detect outcomes more accurately, increase awareness and carefulness about measures that could limit the consequences of an ICU stay, and better define the optimal trajectory during the hospital stay, especially after an ICU hospitalisation. A rigorous and fair scientific assessment is required to demonstrate the benefits of specific geriatric pathways.