Very old patients in the ICU in Latin America: A narrative review

Abstract

The population of very elderly patients (aged 80 years and older) in intensive care units (ICUs) is steadily growing. These patients have unique physiological, cognitive, functional, and social characteristics that affect their entire ICU course. Immobility, delirium, dysphagia, malnutrition, and polypharmacy are among the most common geriatric syndromes in these patients, and they contribute to a higher risk of acute and long-term functional decline and mortality. Risk assessment in very elderly patients is complex, as traditional ICU scoring systems do not account for frailty and baseline disability, making difficult the determination of likely benefits, futility, or harm with ICU interventions. The importance of shared decision-making for treatment plans is critical, as very elderly patients and their families may have uncertain or unrealistic prognostic awareness and expectations of ICU care. Considering the gap between the rapid aging of the population and the socio-health development in Latin America, this population is an important determinant of stress on healthcare systems, however, data on these population is scarce. This review, based on a comprehensive literature search, summarizes recent evidence on triage for ICU admission, specific clinical characteristics, predictive elements of prognosis, and ICU and post-ICU outcomes for very elderly patients while also analyzing the challenges to improve management in the Latin American region.