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Table of Contents
Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 123-124

Critical care in the elderly: Need of the hour

Department of General Medicine, Division of Geriatric Medicine, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Date of Submission28-Apr-2022
Date of Acceptance30-Apr-2022
Date of Web Publication12-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
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcsr.jcsr_74_22

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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

How to cite this URL:
Raju Y S, Regati M. Critical care in the elderly: Need of the hour. J Clin Sci Res [serial online] 2022 [cited 2022 Aug 12];11:123-4. Available from: https://www.jcsr.co.in/text.asp?2022/11/3/123/350741

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.

  References Top

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World Health Organization. Facts about Ageing. Available from: http://www.who.int/ageing/about/facts/en/. [Last accessed on 2018 Aug 25].  Back to cited text no. 2
Population Composition. Available from: http://www.censusindia.gov.in/vital_statistics/SRS_Report/9Chap%202%20-%202011.pdf. [Last accessed on 2018 Aug 30].  Back to cited text no. 3
Central Statistics Office Ministry of Statistics & Programme Implementation Government of India Situation Analysis of Elderly in India; June, 2011. Available from: http://mospi.nic.in/mospi_new/upload/elderly_in_india.pdf. [Last accessed on 2018 Aug 30].  Back to cited text no. 4
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Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59:255-63.  Back to cited text no. 6
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Hurria A, High KP, Mody L, McFarland Horne F, Escobedo M, Halter J, et al. Aging, the medical subspecialties, and career development: Where we were, where we are going. J Am Geriatr Soc 2017;65:680-7.  Back to cited text no. 8
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Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med 2009;169:1712-7.  Back to cited text no. 10
Vidán M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: A randomized, controlled trial. J Am Geriatr Soc 2005;53:1476-82.  Back to cited text no. 11
Schulz AR, Mälzer JN, Domingo C, Jürchott K, Grützkau A, Babel N, et al. Low thymic activity and dendritic cell numbers are associated with the immune response to primary viral infection in elderly humans. J Immunol 2015;195:4699-711.  Back to cited text no. 12
Metcalf TU, Cubas RA, Ghneim K, Cartwright MJ, Grevenynghe JV, Richner JM, et al. Global analyses revealed age-related alterations in innate immune responses after stimulation of pathogen recognition receptors. Aging Cell 2015;14:421-32.  Back to cited text no. 13
Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med 1995;332:1338-44.  Back to cited text no. 14
Fox MT, Persaud M, Maimets I, O'Brien K, Brooks D, Tregunno D, et al. Effectiveness of acute geriatric unit care using acute care for elders components: A systematic review and meta-analysis. J Am Geriatr Soc 2012;60:2237-45.  Back to cited text no. 15
Flood KL, Maclennan PA, McGrew D, Green D, Dodd C, Brown CJ. Effects of an acute care for elders unit on costs and 30-day readmissions. JAMA Intern Med 2013;173:981-7.  Back to cited text no. 16


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