HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

DIFFICULT CASES IN GERIATRIC PATIENTS

Nuran Akıncı Ekinci

Konya City Hospital, Department of Anesthesiology and Reanimation, Konya, Türkiye

Akıncı Ekinci N. Difficult Cases in Geriatric Patients. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.473-482.

ABSTRACT

As the population ages, the number of geriatric patients admitted to intensive care units (ICUs) has increased. Age-related changes occur in organ systems, including changes in body composition and deterioration of the respiratory, cardiovascular, renal, neurological and gastrointestinal systems. The prevalence of chronic disease, decline in organ function and frailty to physical stressors in geriatric patients can complicate the treatment process. Muscle wasting, nutritional deficiencies and changes in drug metabolism in older adults require special attention. In addition, a weakened immune system increases the risk of infection. The ability to regulate body temperature is also reduced, increasing the risk of hypothermia. Pharmacokinetic changes in older adults can affect how medicines are absorbed, distributed throughout the body, metabolised and excreted, thereby affecting their bioavailability and efficacy. In particular, declines in liver and kidney function slow drug metabolism and elimination, while changes in body composition affect drug distribution. In addition, pharmacodynamic changes in the elderly result in increased sensitivity to central nervous system and cardiovascular drugs. Delirium presents with sudden onset of altered consciousness and cognitive impairment. In the ICU, its hypoactive form is more common and is associated with adverse outcomes in elderly patients. The aetiology of delirium results from the interaction of multiple factors, with risk factors including age, cognitive impairment, pharmacological agents and environmental conditions. To minimise the likelihood of delirium in the ICU, early mobilisation, appropriate choice of sedation and implementation of delirium prevention protocols are essential. Euthanasia in the ICU is a complex ethical and medical issue requiring a balance between patient autonomy, the sanctity of life and the principle of “do no harm”. Euthanasia refers to medical interventions designed to end the suffering of patients with terminal illness. However, decisions to withhold or withdraw treatment are also ethically and legally controversial. Geriatric patients in the ICU typically experience higher mortality and longer hospital stays, and treatment decisions should be tailored to the patient’s specific condition and prognosis. ICU treatment plans should respect patient autonomy and take into account the risk-benefit ratio. A multidisciplinary approach and individualised care plans are essential in the management of geriatric patients.

Keywords: Geriatric; ICU; Frailty; Delirium; Euthanasia

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