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Society of Critical Care MedicineCritical Care Medicine2026advanced

Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU.

Published by Society of Critical Care Medicine · GRADE

5Recommendations
36References
3Tables

Summary

AI-generated

Older adults incur over half of ICU days, and this demographic is expected to increase significantly by 2050. They face unique vulnerabilities such as frailty, cognitive impairment, and a higher risk of harm from ICU practices like polypharmacy and immobility. These guidelines offer targeted, evidence-based recommendations for addressing the complex needs of this growing population.

Critical CareGeriatric ICUOlder AdultsDeliriumAntipsychoticsSCCMIntensive CareGuidelines

Key Takeaways

  • 1
    A geriatric model of care is suggested for all older adults admitted to the ICU.
  • 2
    Antipsychotic medications are suggested not to be used for preventing delirium in older adults with critical illness.
  • 3
    No recommendations were made for or against specialized post-ICU follow-up clinics, lower MAP targets in vasodilatory shock, or antipsychotic use for treating existing delirium, highlighting major research gaps.

Key Recommendations

RECOMMENDATIONS

  • rec_1

    We suggest a geriatric model of care for all older adults admitted to the ICU

    ConditionalEvidence: Very low certaintyModel of care
  • rec_2

    We make no recommendation regarding specialized post-ICU follow-up for older survivors of critical illness

    Conditional (No recommendation)Evidence: Low certaintyFollow-up
  • rec_3

    For older adults (age 65 and over) with vasodilatory shock, we make no recommendation with regard to targeting a mean arterial pressure (MAP) of 60–65 mm Hg as compared with usual care (MAP target > 65 mm Hg)

    Conditional (No recommendation)Evidence: Very low certaintyTreatment
  • rec_4

    We suggest not using antipsychotic medications for the prevention of delirium in older adults with critical illness

    ConditionalEvidence: Very low certaintyPrevention
  • rec_5

    We make no recommendation regarding the use of antipsychotic medication in the treatment of delirium in older adults with critical illness

    Conditional (No recommendation)Evidence: Low certaintyTreatment

Scope & Objectives

Clinical Topic

Critical care in older adults

Objectives

To develop evidence-based recommendations addressing the care of older adults during and after critical illness.

Target Patient Population

Older adults (65 years old or greater) with critical illness during and after their ICU stay.

Target Providers

Critical care cliniciansPhysiciansAdvanced practice providersNursesPharmacistsPhysical therapistsOccupational therapists

Patient Criteria & Setting

Therapeutic Area

Critical Care

Guideline Scope

ManagementTreatmentPrevention

Inclusion Criteria

  • Older adult patients (age 65 and older)
  • Admitted to the ICU

Care Settings

Intensive Care Unit (ICU)Post-ICU Outpatient Follow-Up

Special Populations

Older adults (age ≥ 65)Oldest old (age ≥ 80)

Evidence Grading

System: GRADE

Recommendation Strength

Strong RecommendationClinicians should follow for nearly all patients. Most individuals in this situation would want the recommended course of action and only a small proportion would not.
Conditional RecommendationReflects a closer balance between benefits and harms and/or a lower certainty in evidence. The majority of individuals would want the suggested course of action, but many would not. Different choices will be appropriate for different patients.

Authors & Contributors

Lauren E. FerranteDipayan ChaudhuriKallirroi Laiya CarayannopoulosSnigdha JainJudith A. TateEvelyn Álvarez-EspinozaC. Adrian AustinLisa BurryMichael J. DevinneyWilliam J. EhlenbachMary Beth HappAluko A. HopeMay HuaMichelle E. KhoJessica A. PalakshappaLeslie P. ScheunemannLiron SinvaniBarbara StahlSophia WangHannah WunschBram RochwergNathan E. Brummel

Guideline Features

Based on systematic reviewMultidisciplinaryPatient involvement

Learning Context

Difficulty

advanced

Learning Paths

GeriatricsCritical Care MedicineIntensive Care Unit (ICU)Delirium PreventionVasodilatory Shock