[Intensive care medicine in old age : The individual status is the determining factor]

The increasing aging of the population in highly developed countries poses a profound impact on intensive care services. This is illustrated by a finding from a large Austrian database showing that 20% of all intensive care patients are aged ≥80 years. Age per se is not an exclusion criteria for admission to the intensive care unit, but older patients are frequently affected by multiple comorbidities and experience a decreased physiologic reserve. Due to the very heterogeneous population of aged patients and since no generally accepted criteria for admission and treatment of these patients exist, any treatment decision must be made taking into consideration the individual situation. The perspective after possible survival from a critical illness is considered as the most important outcome and goes far beyond the question of survival alone. Many old patients have the chance to return to an acceptable quality of life even after a life-threatening illness. However, with respect to the limitations of human life, it is not justified to start or prolong intensive care in elderly patients without a reasonable possibility of a benefit, which is not soley defined in terms of survival.