Long-term recovery after critical illness in older adults

The population is aging, and recent epidemiologic work reveals that an increasing number of older adults are presenting to the ICU with preexisting geriatric syndromes. In this update, we discuss recent literature pertaining to the long-term recovery of older ICU patients and highlight gaps in current knowledge.

A recent longitudinal study demonstrated that the incidence of frailty, disability, and multimorbidity among older ICU patients is rising; these geriatric syndromes have all previously been shown to impact long-term recovery. Recent studies have demonstrated the impact of social factors in long-term outcomes after critical illness; for example, social isolation was recently shown to be associated with disability and mortality among older adults in the year after critical illness. Socioeconomic disadvantage is associated with higher rates of dementia and disability following critical illness impacting recovery, and further studies are necessary to better understand factors influencing this disparity. The COVID-19 pandemic disproportionately impacted older adults, resulting in worse outcomes and increased rates of functional decline and social isolation. In considering how to best facilitate recovery for older ICU survivors, transitional care programs may address the unique needs of older adults and help them adapt to new disability if recovery has not been achieved.

Recent work demonstrates increasing trends of geriatric syndromes in the ICU, all of which are known to confer increased vulnerability among critically ill older adults and decrease the likelihood of post-ICU recovery. Risk factors are now known to extend beyond geriatric syndromes and include social risk factors and structural inequity. Strategies to improve post-ICU recovery must be viewed with a lens across the continuum of care, with post-ICU recovery programs targeted to the unique needs of older adults.