Geriatric critical care assessment: key considerations.

Area of Science:

• Geriatric Medicine
• Critical Care Medicine
• Public Health

Background:

• Frailty, multimorbidity, and altered physiology significantly impact older adults in critical care.
• Frailty is a more potent predictor of adverse outcomes than age alone.
• Current geriatric critical care models often lack alignment with patient-centered goals.

Purpose of the Study:

• To advocate for a paradigm shift in geriatric critical care towards person-centered, frailty-attuned approaches.
• To emphasize aligning critical care structures and processes with outcomes valued by older adults with frailty.
• To propose practical frameworks for implementing frailty-attuned care.

Main Methods:

• This is a narrative review of the current literature and clinical practices in geriatric critical care.
• It examines the role of frailty in predicting outcomes and influencing management decisions.
• It reviews the ABCDE-Frailty framework and the 5Ms (Mind, Mobility, Medications, Multicomplexity, Matters most) for assessment.

Main Results:

• Frailty screening alone is insufficient without changes in clinical approach.
• The ABCDE-Frailty framework and 5Ms offer a structured method for frailty-attuned assessment.
• Person-centered decision-making, based on shared values and goals, is crucial for proportionate treatment.

Conclusions:

• A paradigm shift from survival-centered to person-centered care is essential in geriatric critical care.
• Care should prioritize dignity, function, and patient-chosen outcomes, avoiding non-beneficial interventions.
• Frailty-attuned geriatric critical care enhances the quality of life and aligns with the values of older adults.