[Special ethical aspects in older intensive care patients]

With demographic shifts, the proportion of older and very old patients in intensive care units is steadily rising. These patients vary widely in their functional reserves and treatment prospects. Multimorbidity, frailty, and impaired decision-making capacity are prevalent, while advance directives are often unclear or outdated. Consequently, determining the appropriate treatment, establishing the patient's wishes, and defining realistic treatment goals present significant challenges. Chronological age alone is a poor predictor of mortality and functional outcomes. Frailty, functional reserve, and the dynamics of the acute illness are far more decisive factors. However, prognostic uncertainty remains substantial. Given the increasing power and high cost of intensive care medicine, necessary political and clinical decisions on resource allocation must never be based solely on chronological age.