[Specialized geriatric care in intensive care units: from frailty to functional prognosis]

Intensive care units (ICUs) increasingly treat very old adults with multimorbidity, frailty, and high medication burden. Chronological age alone is a poor proxy for benefit and prognosis; premorbid function, vulnerability (frailty), and cognitive reserve are pivotal. European cohorts of ICU patients aged ≥ 80 years show a high prevalence of frailty (Clinical Frailty Scale [CFS] ≥ 5 around 43%) and an independent association with 30-day mortality (e.g., hazard ratio [HR] ~1.5 in very old ICU patients [VIP] 1). VIP2 confirmed the prognostic contribution of CFS after adjustment including Sequential Organ Failure Assessment (SOFA) and admission diagnoses. Evidence syntheses and implementation reports suggest that structured bundles (ABCDEF) can improve delirium-related and functional outcomes.

We propose a geriatric ICU bundle integrating frailty assessment, structured goals-of-care (including time-limited trials), delirium prevention, light sedation, early mobilization, protein-adapted nutrition, medication safety, and deprescribing at ICU discharge.

Geriatric critical care represents a paradigm shift from isolated physiological stabilization towards trajectory-based treatment with explicit functional goals. Systematic vulnerability assessment, evidence-based bundles, and time-limited trials may reduce both overtreatment and undertreatment and improve the likelihood of meaningful recovery.