[Very old Patients in the Intensive Care Unit - Balancing Benefits and Risks]

The decision to initiate extended intensive care in older patients is often challenging. The ethical principles of beneficence and non-maleficence, together with the patient's autonomous will, form the foundation of decision-making. Important prognostic factors include frailty, functional status, and comorbidities. If intensive care treatment is initiated, it should be started promptly, but with a clearly defined treatment goal and predefined limitations regarding interventions that should not be undertaken. If, during the course, the decision is made against curative intensive care, palliative care should be provided. In situations where the patient's wishes or prognosis are unclear and the likelihood of meaningful benefit is low, a time-limited trial of therapy with predefined evaluation criteria may be appropriate. In any case, interdisciplinary and interprofessional team discussions help to improve prognostic assessment. Based on this, patients and their relatives can engage in shared decision-making to weigh benefits against burdens and to reach an informed choice.