Admission Criteria for Critically Ill Older Adults

Principles of Admission

The World Society of Emergency Surgery (WSES) recommends that age alone should not be used as a criterion for denying ICU admission, and decisions should be based on an evaluation of frailty, prior functional status, specific comorbidities, and severity of acute illness 1, 2
The American College of Surgeons and other societies suggest that the decision to admit to ICU should consider multiple factors beyond chronological age, including the patient's overall health status and potential for recovery 1, 2

The World Health Organization (WHO) and other health organizations recommend a structured evaluation that includes signs of vital organs, mechanism of injury/severity of acute illness, evaluation of frailty using the Clinical Frailty Scale (CFS), and history of comorbidities and medications 3
The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) establish mandatory ICU admission criteria for patients with sepsis, including the need for invasive mechanical ventilation and septic shock requiring vasopressors 4

For community-acquired pneumonia, a CURB-65 score ≥3 requires hospitalization and evaluation for ICU admission, with a mortality rate of 14.5% for a score of 3 and 40-57% for scores of 4-5 3, 4
For trauma, early activation of the trauma protocol in patients ≥55 years is recommended, and scores like GTOS (Geriatric Trauma Outcome Score) or qEMAT can be used for risk stratification 1, 2

The World Society of Emergency Surgery (WSES) identifies factors independently associated with mortality, including prior functional status, comorbidities, and severity of acute illness 1, 2

Patients with CFS ≥5 (moderate to severe frailty) require special considerations in ICU admission decisions, but this does not mean automatic exclusion 3
The decision to admit to ICU should be made through a multidisciplinary approach that considers the patient's prognosis, potential for recovery, and quality of life 1, 2

Approximately 50% of survivors >65 years were discharged home in a retrospective study of 38,707 patients, and 83% of patients ≥75 years who survived 4 years after injury lived in an independent environment 1, 2

The average mortality rate in ICU is approximately 35%, with significant variation depending on the patient population and underlying conditions 5

Delaying transfer to ICU for respiratory failure or septic shock is associated with higher mortality, and approximately 45% of patients who eventually require ICU admission were initially admitted to a non-ICU setting 4
Clinical judgment remains essential in making decisions about ICU admission 4