The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care?

Michael Beil,Christian Jung,Dylan De Lange,Sigal Sviri,Bertrand Guidet,Susannah Leaver,Jesper Fjølner,Wojciech Szczeklik,Hans Flaatten,Peter Vernon Van Heerden

doi:10.1186/s13054-021-03750-y

Abstract

There is ongoing demographic ageing and increasing longevity of the population, with previously devastating and often-fatal diseases now transformed into chronic conditions. This is turning multi-morbidity into a major challenge in the world of critical care. After many years of research and innovation, mainly in geriatric care, the concept of multi-morbidity now requires fine-tuning to support decision-making for patients along their whole trajectory in healthcare, including in the intensive care unit (ICU). This article will discuss current challenges and present approaches to adapt critical care services to the needs of these patients.

Highlights

Multi-morbidity is defined as the co-occurrence of multiple, usually two or more, chronic conditions in an individual [1]
During the COVID-19 pandemic, the National Institute for Health and Care Excellence in the UK had to recommend a more holistic approach beyond single scores for organ failure or frailty for deciding about admission to critical care. It advised that comorbidities and underlying health conditions should be considered when assessing the potential benefit of critical care for the individual patient [15]
The analysis of data obtained in realistic scenarios will help to develop quantitative, individually precise and, clinically useful concepts of multi-morbidity

Summary

Introduction

Multi-morbidity is defined as the co-occurrence of multiple, usually two or more, chronic conditions in an individual [1]. Even in intensive care units (ICUs) designed to manage single-organ conditions, such as cardiac/coronary ICU’s, multi-morbidity has become highly prevalent and an important contributor to outcome prediction [13]. It advised that comorbidities and underlying health conditions should be considered when assessing the potential benefit of critical care for the individual patient [15].

Results

Conclusion