Controversial issues in critical care for the elderly: a perspective from Canada

Age alone does not at all preclude the possibility of warranted, effective, and successful intensive care. From a medical perspective, the key issue is the reversibility or otherwise of an acute illness and where this illness sits in the trajectory of that individual's life and possible death. It makes no more sense to admit a 19-year-old let alone a 91-year-old to an intensive care unit if intensive care cannot provide what is needed. Of paramount importance in our consideration of critical care for the elderly is a determination and an understanding of the many needs--medical, emotional, social, spiritual, psychologic--that elderly people have. By exploring them with compassion and sensitivity, we can establish whether the goals of care include critical care and the associated technology, or whether alternative and more conservative approaches more closely reflect the values and preferences of an increasingly elderly population.