Should the oldest-old be admitted to the intensive care unit and receive advanced life-supporting care?

摘要

It is extremely important that the implications and outcomes of population aging are studied in relation to advancements in critical care. Not only are technologic and knowledge developments raising the efficacy of life support in general, but, as the insightful study by Lerolle et al illustrates, these developments are also helping to change the dynamics of their use (1). Their study found advanced intensive care unit (ICU) support was consistently provided over a 10-year period and has become increasingly effective at saving the lives of people who are >80 yrs of age. This is an important study because it clearly addresses contentious questions about who should be provided ICU care. With ICU care an extremely expensive, highly rationed, and morally charged health service, it is reasonable to expect that patients receiving ICU care should be the most appropriate in terms of illness severity and probability of positive outcomes. It would therefore be logical to question when or if ICU care is appropriate for people who are very advanced in age. Some authors have openly and repeatedly questioned if elderly persons, specifically those at the upper reaches of longevity, should be entitled to life-preserving health care (2).