Table 4 Key messages and unresolved issues

Triage

Seek for advance directives—How promoting diffusion?

Every time it is possible, ask the patient about his/her wishes

If the patient is unable to communicate, seek for relatives/family wishes

Try to estimate the immediate and long-term risk of death considering

 Patient baseline characteristics:

  Age

  Functional status (Clinical Frailty Scale, frailty phenotype, Performance status)

  Comorbidities including cancer

  Nutritional status and protein–energy balance

  Cognitive and psychiatric disorders

 Type of admission: scheduled versus urgent

 Reason for admission

 Acute severity—a specific score tailored to old patient should be available

Mobilize geriatric expertise if possible—impact should be proved by interventional studies

Define a goal of care anticipating second evaluation after few ICU days—Impact on triage, mortality, LOS, LST limitation?

If the patient is denied ICU admission consider palliative care

During the ICU stay

Organ support guidelines might not be appropriate for old patients—Interventional studies focusing on older adults

  Fluid loading

  Ventilator settings

  Weaning strategy

Special attention to medication with high risk of

  Overdose

  Interaction

Consider LST limitation in case of poor response to initial treatment—Harmonize practice within and between countries

ICU discharge—Intervention that should be tested in prospective trials

 Patients are seen by a geriatrician after ICU discharge

 They are discharged to specialized geriatric unit

 Discuss timing

Long-term outcomes

 Test the impact of early rehabilitation on mortality, HRQOL and functional status

 Consider the burden for the house caregivers