Decisions to admit older, frail patients to critical care must pay particular attention to quality of life and the potential burden of care on patients. This burden may extend beyond surviving a critical illness. These decisions are not easy and require careful thought, clinical judgment, and communication.
Critical care that enables survival “sans teeth, sans eyes, sans taste, sans everything”1 can go against the wishes of patients and their families, often incurring significant use of health and social care resources and informal care costs. As the UK’s demographics shift, with more older people living with multiple comorbidities or frailty, the public should be aware of the advantages and disadvantages of intensive care. We must consider what people really want from medical interventions towards the final stage of their lives.
People aged over 80 currently represent one in seven intensive care admissions in the UK.2 In this age cohort the balance of considering quality of li
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### What you need to know
Sepsis is a common cause for hospital admission that carries a high risk of death.1 In 2021-22, over 100 000 emergency admissions with sepsis were reported in England and Wales, with a mean patient age of 71 years.2 Adults admitted to hospital with sepsis are typically older and often have multimorbidity and functional limitations.3 Increasing degrees of frailty are associated with increased mortality in older people hospitalised for any reason,4 and illness severity and frailty synergistically increase the risk of death.5
Clinicians caring for older adults with sepsis need to understand how frailty and comorbidities complicate the diagnosis and management of suspected sepsis.6 Guidelines for managing sepsis789 draw on substantial evidence from critical care, but one single-centre retrospective cohort study found that only 10% of 251 adults meeting the diagnostic criteria for sepsis were referred to critical care.3 We therefore need to adapt existing guide
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