Skip to main content
Home
Zeitschriften
Zeitungen
Podcast
Gesundheitspolitik
Praxis
Allerlei
Jobs
Fachgebiete
Allgemeinmedizin Anästhesiologie & Intensivmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kinder & Jugendheilkunde Neurologie & Psychiatrie Orthopädie & Unfallchirurgie Pflege Urologie Zahnmedizin Apotheke
Subfächer Innere Medizin
Diabetologie Gastroenterologie Infektiologie Kardiologie Onkologie und Hämatologie Pneumologie Rheumatologie
Fortbildungen
Überblick Fortbildungen DFP-Literaturstudium-Artikel DFP-Webcast Fortbildungen DFP-Podcasts
Erweiterte Suche
Anmelden
nach oben
Wiener Medizinische Wochenschrift
Erschienen in: Wiener Medizinische Wochenschrift 5-6/2022

10.01.2022 | main topic

Intensive care of geriatric patients—a thin line between under- and overtreatment

verfasst von: Univ.-Prof. Dr. med. Hans Jürgen Heppner, MHBA, Hag Haitham

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 5-6/2022

Einloggen, um Zugang zu erhalten

Summary

Demographic developments are leading to an ever-increasing proportion of elderly and aged patients in hospitals at all levels of care, and even more patients from these age groups are to be expected in the future. Based on the projected population development, e.g., in Norway, an increase in intensive care beds of between 26 and 37% is expected by 2025. This poses special challenges for the treatment and management of geriatric intensive care patients. The acute illness is not the only decisive factor, but rather the existing multimorbidity and functional limitations of this vulnerable patient group must likewise be taken into account. Age per se is not the sole determinant of prognosis in critical patients, even though mortality increases with age.
Vorheriger Artikel Editorial
Nächster Artikel Polypharmacy in elderly people
Literatur
1.
Bartels O. Intensivtherapie aus internistischer Sicht. In: Lang K, editor. Intensivtherapie im Alter. Berlin, Heidelberg, New York: Springer; 1974. pp. 86–99.
2.
Lawin P, editor. Praxis der Intensivbehandlung. 3rd ed. Stuttgart: Thieme; 1975.
3.
Vosylius S, Sipylaite J, Ivaskevicius J. Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing. 2005;35:157–62.
4.
Leblanc G, Boumendil A, Guidet B. Ten things to know about critically ill elderly patients. Intensive Care Med. 2017;43:217–9.PubMed
5.
Bagshaw SM, Webb SA, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care. 2009;13:R453.
6.
Laake JH, Dybwik K, Flaatten HK, et al. Impact of the post-World War II generation on intensiv care needs in Norway. Acta Anaesthesiol Scand. 2010;54:479–84.PubMed
7.
8.
Grenness C, Meyer C, Scarinci N, et al. The international classification of functioning, disability and health as a framework for providing patient- and family-centered audiological care for older adults and their significant others. Semin Hear. 2016;37:187–99.PubMedPubMedCentral
9.
Heppner HJ, Sieber C, Walger P, et al. Infections in the elderly. Crit Care Clin. 2013;46:361–71.
10.
Steinman MA, Lee SJ, Boscardin WJ, et al. Patterns of multimorbidity in elderly veterans. J Am Geriatr Soc. 2012;60:1872–80.PubMedPubMedCentral
11.
Müller-Werdan U, Heppner HJ. Michels G geriatric intensive care patients: perspectives and limits of geriatric intensive care medicine. Med Klin Intensivmed Notfmed. 2018;113:256–9.PubMed
12.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39:412–23.PubMedPubMedCentral
13.
Heppner HJ, Bauer JM, Sieber CC, et al. Laboratory aspects relating to the detection and prevention of frailty. Int J Prev Med. 2010;1:149–57.PubMedPubMedCentral
14.
15.
Jung C, Bruno RR, Wernly B, et al. Frailty as a prognostic indicator in intensive care. Dtsch Arztebl Int. 2020;117:668–73.PubMedPubMedCentral
16.
Muscedere J, Waters B, Varambally A, et al. The impact of frailty on intensive care unit outcomes. Intensive Care Med. 2017;43:1105–22.PubMedPubMedCentral
17.
Romero-Ortuno R, Walölis S, Biram R, et al. Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: an observational study. Eur J Intern Med. 2016;35:24–34.PubMed
18.
Shears M, Takaoka A, Rochwerg B, et al. Assessing frailty in the intensive care unit: a reliability and validity study. J Crit Care. 2018;45:197–203.PubMed
19.
Nau R, Djukic M, Seele J, et al. Warum sind Infektionen bei Senioren so gefährlich? Neurotransmitter. 2021;32:1–2.
20.
Welte T. Community-acquired pneumonia: a disease of the elderly. Z Gerontol Geriatr. 2011;44:221–8.PubMed
21.
LaMantia MA, Platts-Mills TF, Biese K, et al. Predicting hospital admission and returns to the emergency department for elderly patients. Acad Emerg Med. 2010;17:252–9.PubMedPubMedCentral
22.
Thiem U, Niklaus D, Sehlhoff B, et al. C‑reactive protein, severity of pneumonia and mortality in elderly, hospitalised patients with community-acquired pneumonia. Age Ageing. 2009;38:693–7.PubMed
23.
Heppner HJ, Bertsch T, Alber B, et al. Procalcitonin: inflammatory biomarker for assessing the severity of community-acquired pneumonia—a clinical observation in geriatric patients. Gerontology. 2010;56:385–9.PubMed
24.
Singer M, Deutschmann CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315:788–800.
25.
Kellett J, Nickel CH. What are nonspecific complaints and what are their causes and outcomes? The common unknown unknowns of medicine. Eur J Intern Med. 2018;47:e12–e3.PubMed
26.
27.
Platts-Mills TF, Travers D, Biese K, et al. Acad accuracy of the emergency severity index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Emerg Med. 2010;17:238–43.
28.
Mandal AKJ, Gan J, Chauhan R, et al. COVID-19 in older adults: typically atypical. Geriatr Gerontol Int. 2021;21:119–20.PubMed
29.
Davoudi A, Corbett DB, Ozrazgat-Baslanti T, et al. Activity and circadian rhythm of sepsis patients in the intensive care unit. IEEE EMBS Int Conf Biomed Health Inform. 2018;16:17–20.
30.
Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35:350–64.PubMed
31.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22.
32.
Singler K, Thiem U, Christ M, et al. Aspects and assessment of delirium in old age. First data from a German interdisciplinary emergency department. Z Gerontol Geriatr. 2014;47:680–5.PubMed
33.
Müller A, Weiß B, Spies CD, et al. Symptomatic treatment of delirium, anxiety and stress, and protocol based analgesia, sedation and management of sleep in intensive care patients. Anasthesiol Intensivmed Notfallmed Schmerzther. 2015;50:698–703.PubMed
34.
35.
36.
Gurlit S, Möllmann M. How to prevent perioperative delirium in the elderly? Z Gerontol Geriatr. 2008;41:447–52.PubMed
37.
Singler K, Christ M, Sieber C, et al. Geriatric patients in emergency and intensive care medicine. Internist (Berl). 2011;52:934–8.
38.
39.
Heppner HJ, Singler K, Sieber CC, et al. Evidence-based medicine: implications from the guideline “non-invasive ventilation” in critically ill elderly patients. Z Gerontol Geriatr. 2011;44:103–8.PubMed
40.
Lerolle N, Trinquart L, Bornstain C, et al. Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med. 2010;38:59–64.PubMed
41.
Berdowski J, Berg RA, Tijssen JG, et al. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resucitation. 2010;81:1479–87.
42.
Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics-2018 update: a report from the American heart association. Circulation. 2018;137:e67–e492.
43.
Nielsson MS, Christiansen CF, Johansen MB, et al. Mortality in elderly ICU patients: a cohort study. Acta Anaesthesiol Scand. 2014;58:19–26.PubMed
44.
Dumont JA, Burval DJ, Sprung J, et al. Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of “limited” resuscitation. Arch Intern Med. 2001;161:1751–8.
45.
Elshove-Bolk J, Guttormsen AB, Austlid I. In-hospital resuscitation of the elderly: characteristics and outcome. Resuscitation. 2007;74:372–3376.PubMed
46.
Günther A, Schildmann J, in der Schmitten J, et al. Opportunities and risks of resuscitation attempts in nursing homes-facts for nursing home residents and caregivers. Dtsch Arztebl Int. 2020;117:757–63.PubMedPubMedCentral
47.
Vaux J, Lecarpentier E, Heidet M, et al. Management and outcomes of cardiac arrests at nursing homes: a French nationwide cohort study. Resuscitation. 2019;140:86–92.PubMed
48.
Roedl K, Jarcezak D, Becker S, et al. Longterm neurological outcomes in patients aged over 90 years who are admitted to the intensive care unit following cardiac arrest. Resuscitation. 2018;132:6–12.PubMed
49.
Sacanella E, Pérez-Castejón JM, Nicolás JM, et al. Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study. Crit Care. 2011;5:R105.
50.
Stricker KH, Sailer S, Uehlinger DE, et al. Quality of life 9 years after an intensive care unit stay: a long-term outcome study. J Crit Care. 2011;26:379–87.PubMed
51.
Sligl WI, Eurich DT, Marrie TJ, et al. Age still matters: prognosticating short- and long-term mortality for critically ill patients with pneumonia. Crit Care Med. 2010;38:2126–32.PubMed
52.
Qiang XH, Yu TO, Li YN, et al. Prognosis risk of urosepsis in critical care medicine. Biomed Res Int. 2016;2016:9028924.PubMedPubMedCentral
53.
Wehler M. Langzeitprognose alter Intensivpatienten nach intensiv-medizinischer Behandlung. Med Klin Intensivmed Notfmed. 2011;106:29–33.PubMed
54.
Anica C, Turnbull AE. Patient-centered outcomes after sepsis. Chest. 2020;158:1808–9.
55.
Mankowski RT, Anto SD, Ghita SL, et al. Older sepsis survivors suffer persistent disability burden and poor long-term survival. J Am Geriatr Soc. 2020;689:1962–9.
56.
Meurer WJ, Losmann ED, Smith BL, et al. Short-term functional decline of older adults admitted for suspected sepsis. Am J Emerg Med. 2011;29:936–42.PubMed
57.
Brunner-Ziegler S, Heinze G, Ryffel M, et al. “Oldest old” patients in intensive care: prognosis and therapeutic activity. Wien Klin Wochenschr. 2007;119:14–9.PubMed
58.
Sprung CL, Baras M, Iapichino G, et al. The eldicus prospective, observational study of triage decisionmaking in European intensive care units: part I—European intensive care admission triage scores. Crit Care Med. 2012;40:125–31.PubMed
59.
Tabah A, Philippart F, Timsit JF, et al. Quality of life in patients aged 80 or over after ICU discharge. Crit Care. 2010;14:R2.PubMedPubMedCentral
60.
Boumendil A, Aegerter P, Guidet B, CUB-Rea Network. Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc. 2005;531:88–93.
61.
Sprung CL, Artigas A, Kesecioglu J, et al. The eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly. Crit Care Med. 2012;40:132–8.PubMed
62.
Wirth R, Sieber CC. Health care professionals underestimate the mean life expectancy of older people. Gerontology. 2012;581:56–9.
63.
Anonymous Konsensuspapier der Intensivmedizinischen Gesellschaften Osterreichs. Empfehlungen zum Thema Therapiebegrenzung und -beendigung an Intensivstationen. Wien Klin Wochenschr. 2004;116:763–7.
64.
Valentin A. Intensivmedizin im Alter. Med Klin Intensivmed Notfmed. 2017;112:303–7.PubMed
Metadaten
Titel
Intensive care of geriatric patients—a thin line between under- and overtreatment
verfasst von
Univ.-Prof. Dr. med. Hans Jürgen Heppner, MHBA
Hag Haitham
Publikationsdatum
10.01.2022
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 5-6/2022
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-021-00902-1

Weitere Artikel der Ausgabe 5-6/2022

Wiener Medizinische Wochenschrift 5-6/2022 Zur Ausgabe

main topic

Delirium in geriatric patients

main topic

Polypharmacy in elderly people

editorial

Editorial

original article

Histopathological progression of hidradenitis suppurativa/acne inversa

original article

Food additive E407a stimulates eryptosis in a dose-dependent manner

main topic

Comprehensive geriatric assessment