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Acute and Critical Care > Volume 37(3); 2022 > Article
Shin: We need a comprehensive intensive care unit management strategy for older patients
According to the United Nations, there were 703 million persons aged 65 years or over in 2019. The number of older persons is projected to reach 1.5 billion in 2050. Globally, the proportion of the population aged 65 years or over increased from 6% in 1990 to 9% in 2019. This share is projected to rise further to 16% by 2050. Population aging has been fastest in Eastern and South-Eastern Asia [1]. The Republic of Korea is rapidly becoming an aging society. In Korea, the proportion of older adults (65 or over) increased from 11.5% in 2012 to 16.5% in 2021 [2]. Considering the course of natural tendency in demographic shift, it is very likely that Korea will become a super-aging country by 2029 [3]. Older age is related to a higher prevalence of chronic diseases, which may cause increased incidence rate of acute critical illnesses and admission to the intensive care unit (ICU) [4].
In this issue of Acute and Critical Care, Lee et al. [5] studied the change in the characteristics and prognostic factors of very old patients (85 or over) admitted to the ICU over 11 years from 2007 to 2017. They retrospectively investigated the data of patients admitted to the ICU, comparing the first and second halves of the research period; the share of very old adults increased from 1.3% to 1.8%. They report that the in-hospital mortality of very old ICU patients decreased, but that abnormal creatinine, vasopressor use, and ventilator weaning failure were associated with mortality [5].
Despite the limitations of a single-center retrospective cohort study, this study by Lee et al. [5] is very challenging and revealed the importance of ICU treatment for older patients. This study showed that the mortality of very old ICU patients decreased and suggested meaningful prognostic factors related to in-hospital mortality. To be sure, this study used limited data, which some might characterize as insufficiently reliable. Therefore, for generalization, prospective multicenter-based clinical trials are needed. As the number of older patients is continuing to increase dramatically, their socioeconomic burden will increase. As healthcare resources are limited, a comprehensive ICU management strategy for this population is becoming important for critical care physicians. I hope this article is able to provide an impetus for strengthening these strategies.



No potential conflict of interest relevant to this article was reported.


1. United Nations, Department of Economic and Social Affairs, Population Division. World population ageing 2019: highlights. New York: United Nations; 2019.

2. KOSIS. 100 Indicators of KOSIS [Internet]. Daejeon: KOSIS; 2021 [cited 2021 May 17]. Available from: https://kosis.kr/visual/nsportalStats/index.do?menuId=all.

3. Kim KW, Kim OS. Super aging in South Korea unstoppable but mitigatable: a sub-national scale population projection for best policy planning. Spat Demogr 2020;8:155-73.
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4. Al-Dorzi HM, Tamim HM, Mundekkadan S, Sohail MR, Arabi YM. Characteristics, management and outcomes of critically ill patients who are 80 years and older: a retrospective comparative cohort study. BMC Anesthesiol 2014;14:126.
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5. Lee SI, Koh Y, Huh JW, Hong SB, Lim CM. Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit. Acute Crit Care 2022;37:372-81.
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