Scholarlink

Background <p>Intensive care units (ICUs) increasingly treat very old adults with multimorbidity, frailty, and high medication burden. Chronological age alone is a&#xa0;poor proxy for benefit and prognosis; premorbid function, vulnerability (frailty), and cognitive reserve are pivotal. European cohorts of ICU patients aged ≥ 80&#xa0;years show a&#xa0;high prevalence of frailty (Clinical Frailty Scale [CFS] ≥ 5 around 43%) and an independent association with 30-day mortality (e.g., hazard ratio [HR] ~1.5 in very old ICU patients [VIP]&#xa0;1). VIP2 confirmed the prognostic contribution of CFS after adjustment including Sequential Organ Failure Assessment (SOFA) and admission diagnoses. Evidence syntheses and implementation reports suggest that structured bundles (ABCDEF) can improve delirium-related and functional outcomes.</p> Methods <p>We propose a&#xa0;geriatric ICU bundle integrating frailty assessment, structured goals-of-care (including time-limited trials), delirium prevention, light sedation, early mobilization, protein-adapted nutrition, medication safety, and deprescribing at ICU discharge.</p> Conclusion <p>Geriatric critical care represents a&#xa0;paradigm shift from isolated physiological stabilization towards trajectory-based treatment with explicit functional goals. Systematic vulnerability assessment, evidence-based bundles, and time-limited trials may reduce both overtreatment and undertreatment and improve the likelihood of meaningful recovery.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Spezialisierte geriatrische Betreuung auf der Intensivstation: von Frailty zur funktionellen Prognose

  • 期刊论文

  • 发表日期：

    2026年4月1日

查看全文
  • Henning Lemm,
  • Matthias Janusch,
  • Ursula Müller-Werdan

摘要

Background

Intensive care units (ICUs) increasingly treat very old adults with multimorbidity, frailty, and high medication burden. Chronological age alone is a poor proxy for benefit and prognosis; premorbid function, vulnerability (frailty), and cognitive reserve are pivotal. European cohorts of ICU patients aged ≥ 80 years show a high prevalence of frailty (Clinical Frailty Scale [CFS] ≥ 5 around 43%) and an independent association with 30-day mortality (e.g., hazard ratio [HR] ~1.5 in very old ICU patients [VIP] 1). VIP2 confirmed the prognostic contribution of CFS after adjustment including Sequential Organ Failure Assessment (SOFA) and admission diagnoses. Evidence syntheses and implementation reports suggest that structured bundles (ABCDEF) can improve delirium-related and functional outcomes.

Methods

We propose a geriatric ICU bundle integrating frailty assessment, structured goals-of-care (including time-limited trials), delirium prevention, light sedation, early mobilization, protein-adapted nutrition, medication safety, and deprescribing at ICU discharge.

Conclusion

Geriatric critical care represents a paradigm shift from isolated physiological stabilization towards trajectory-based treatment with explicit functional goals. Systematic vulnerability assessment, evidence-based bundles, and time-limited trials may reduce both overtreatment and undertreatment and improve the likelihood of meaningful recovery.