[Admission to intensive care of very old patients].
THE EXTENT OF THE PROBLEM: Because of the costs of intensive care, there is a possibility that access to this sector may be limited for those above a certain age. It would therefore appear necessary to develop an ethical clinical strategy in order to assess as precisely as possible and on individual level, the benefits and risks of these techniques, since age itself is simply a criterion among so many others. Among the elements that are important for the decision is the respect of the patient's wish, when it can be obtained since this is a fundamental point. In studies conducted in the United States, 50 to 90% of the elderly persons interviewed did not wish to be resuscitated in the case of cardiac arrest. CRITERIA FOR ADMISSION: The decision to admit an elderly patient in an intensive care unit must take into account the functional state of the patient, appreciated on daily activity and mobility scores and the neuro-psychological assessment, before hospitalization. In parallel, the severity of the underlying disease and the impact on visceral failures, assessed by the severity scores on admission appear to be more reliable prognostic elements than the patients' age itself. FOLLOWING RESUSCITATION: The quality of life of elderly patients within the months following resuscitation is difficult to assess, but is considered as acceptable in the majority of surviving patients.


CONCLUSIONS
The choice of admission in intensive care of an elderly patient requires a multidisciplinary approach that takes into account the patient's and/or family's wishes, the benefit/risk ratio of the technical act but which also, in certain cases, bears in mind the principle of end of life and the patient's dignity.
Aubé
Hervé
H
Service de réanimation médicale, Hôpital Général, CHU de Dijon.
Pfitzenmeyer
Pierre
P
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000331:legislation & jurisprudence; D004992:Ethics, Medical; D016330:Frail Elderly; D005602:France; D015276:Health Care Rationing / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000331:legislation & jurisprudence; D010343:Patient Admission / Q000191:economics / Q000331:legislation & jurisprudence; D011788:Quality of Life; D016414:Resuscitation Orders