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| EDITORIAL |
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| Year : 2022 | Volume
: 11
| Issue : 3 | Page : 123-124 |
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Critical care in the elderly: Need of the hour
Y Sathyanarayana Raju, Maneesha Regati
Department of General Medicine, Division of Geriatric Medicine, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| Date of Submission | 28-Apr-2022 |
| Date of Acceptance | 30-Apr-2022 |
| Date of Web Publication | 12-Jul-2022 |
Correspondence Address:
Y Sathyanarayana Raju
Professor, Department of General Medicine, Division of Geriatric Medicine, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500 082, Telangana
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jcsr.jcsr_74_22
How to cite this article:
Raju Y S, Regati M. Critical care in the elderly: Need of the hour. J Clin Sci Res 2022;11:123-4 |
Elderly population has been increasing globally.[1] The World Health Organization (WHO) estimates that the proportion of older adults (>60 years) will double from 11% in 2000 to 22% by 2050.[2] It has also been estimated that, in Asia, the proportion of adults aged 65 years or older will increase from 59% to 12%.[2] India is the home to the second largest geriatric population in the world. It has been estimated that in India, the proportion of elderly (age >60 years) is estimated to increase to 10.7% by 2021.[3],[4]
The disease burden grows with increasing life expectancy. Hence, the diversity, severity and complexity of illnesses are expected to occur, especially requiring admission to intensive care units (ICUs). As a result, the number of medical care facilities providing intensive care/critical care has been on the rise. Older adults are vulnerable due to factors such as multi-morbidity, frailty and disability which are prevalent with increasing age.[5] Moreover, there is an increased risk of adverse outcomes. In some cases, these factors overlap, conferring even greater risk.[6] Many intensivists adapt the existing evidence to treat the older adults admitted in the ICU. (The treatment given to the older adults is given intuitively, not backed by evidence). However, there is a lack of formal training about principles of geriatric care and management. Few clinical conditions are age related but do not fit into discrete disease category, which are called geriatric syndromes (frailty, functional limitation, cognitive impairment and delirium, depression, etc.). Therefore, a field of 'geriatric critical care medicine' is being proposed to give the best care to the older adults with critical illnesses.[7]
A gap can occur between the number of trained geriatricians and the fast growing ageing population. Hence, integrating geriatrics into the field of critical care is necessary.
In addition, collaborating geriatrics into other disciplines has improved the outcomes in many groups of older adults. This includes reduction in complications such as delirium, length of hospital stay and mortality benefit. These co-management strategies help in providing better care.[8],[9],[10],[11],[12],[13]
An important entity to be considered in this regard is 'homeostenosis', i.e., decreased physiological reserve with ageing. Reduced ability to respond or fight back in the event of an insult/injury/stressor is the main principle of homeostenosis making an older adult vulnerable to adverse outcomes. However, not all individuals of same age are equally vulnerable. Age is not the only predictor of outcomes in a critically ill older adult. There are many factors that would determine the outcomes and recovery when an insult happens, i.e., pre-existing factors that increase the vulnerability (e.g., frailty), triggering factors that cause acute worsening (e.g., infection, fall) and factors that prolong the recovery period (e.g., delirium). Immunosenescence (age-associated gradual deterioration of protective immunity) and inflammaging (chronic subclinical systemic inflammation) are the two main phenomena that result in systemic deterioration, leading to increased susceptibility to chronic illnesses.
Integrating the principles of geriatrics into critical care medicine has been emphasised earlier in the form of well-established models 'acute geriatric care', Acute Care for Elders programmes through an interdisciplinary team approach.[12],[13],[14],[15],[16] Team includes physicians, nurse, physiotherapist, social worker and dietitian. However, this is not being practiced in the critical care units. The coordinated care to rehabilitate and reduce the dependency starts from the time of admission.
More research and data are needed to enhance our knowledge about how ageing interacts with critical illness.
Conflicts of Interest
Y Sayanarayana Raju is an Editorial Board member of Journal of Clinical and Scientific Research. The article was subject to the journal's standard procedures, with peer review handled independently of this member and his research groups.
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