7th April 2017, Volume 130 Number 1453

Owen Keet, Stephanie Chisholm, Jennifer Goodson, Troy Browne

Admitting very elderly patients to intensive care units (ICU) is a controversial issue. With current demographic projections, increasing life expectancy and increasing complexity of interventions, we will see many more…

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The decision whether to admit and treat the very elderly patient with septic shock in ICU is a complex decision. Although age in itself is not a reason to deny a patient ICU admission, it is taken into account in context of the burden of chronic and acute disease. The patient selection and subsequent treatment at Tauranga Hospital, a secondary level New Zealand hospital, produced results that saw most of the patients during a five-year period, including those >85 years, being discharged alive from hospital. This study suggests that with carefully considered selection, elderly patients greater than 85 years may have an acceptable long-term outcome following an episode of septic shock.



Admitting very elderly, critically ill patients to ICU is controversial. We compared our mortality data in a subgroup of elderly patients to internationally published outcomes.


Tauranga Hospital ICU retrospectively investigated their mortality outcomes for patients with septic shock. The ANZICS adult database (AORTIC), Tauranga Hospital computer records and medical records were used to identify the study cohort and provide information on demographics, admission times and shock types between January 2009 and December 2014. Patients were divided into groups; not old (<74 years), old (75–84 years) and very old (>85 years) to compare survival statistics at ICU discharge, hospital discharge, 28 days, six months and 12 months.


Patients in the >85 year group at Tauranga ICU had a 38.5% survival.


With careful selection, elderly patients with septic shock may have an acceptable outcome.

Author Information

Owen Keet, Intensive Care, Tauranga Hospital, Tauranga; Stephanie Chisholm, Medical School, Auckland University, Auckland; Jennifer Goodson, Intensive Care, Bay of Plenty District Health Board, Bay of Plenty; Troy Browne, Intensive Care, Tauranga Hospital, Tauranga.


Dr Owen Keet, Intensive Care, Tauranga Hospital, Cameron Road, Tauranga 3143.

Correspondence Email


Competing Interests



  1. Nguyen YL, et al. The challenge of admitting the very elderly to intensive care. Ann Intensive Care, 2011. 1(1):29.
  2. Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B. Should elderly patients be admitted to the intensive care unit? Intensive Care Med. 2007; 337:1252–1262.
  3. Nathanson BH, Higgins TL, Brennan MJ, Kramer A, et al. Do elderly patients fare well in the ICU? Chest. 2011; 139:825–831.
  4. Lerolle N, Trinquart L, Bornstain C, Tadie JM, et al. Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med. 38(1):59–64.
  5. Bagshaw SM, Kelley MA, Delaney A, George C, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care. 2009; 13(2):R45.
  6. de Rooij SE, Abu-Hanna A, Levi M, de Jonge E. Factors that predict outcome of intensive care treatment in very elderly patients: a review. Crit Care. 2005; 94:R307–R314.
  7. Tabah A, Philippart F, Timsit JF, Willems, et al. Quality of life in patients aged 80 or over after ICU discharge. Crit Care. 2010; 14(1):R2. 10.1186/cc8231
  8. Biston P, et al. Outcome of elderly patients with circulatory failure. Intensive Care Med. 2014; 40(1):50–6.
  9. De Backer D, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010; 362(9):779–89.
  10. Roch A, Wiramus S, Pauly V, Forel JM, et al. Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care. 2011; 15(1):R36. 10.1186/cc9984
  11. Statistics New Zealand http://www.stats.govt.nz/Census/2006CensusHomePage/QuickStats/AboutAPlace/SnapShot.aspx?tab=Agesex&id=2000023
  12. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, et al. EPIC II Group of Investigators (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA. 302:2323–2329.
  13. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, et al. Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000–2012. JAMA. 2014; 311(13):1308–1316.
  14. Farfel JM, Franca SA, Sitta Mdo C, Filho WJ, et al. Age, invasive ventilatory support and outcomes in elderly patients admitted to intensive care units. Age Ageing. 2009; 38(5):515–520.
  15. Ministry of Health Population of BOPDHB http://www.health.govt.nz/new-zealand-health-system/my-dhb/bay-plenty-dhb/population-bay-plenty-dhb
  16. Ministry of Health NZ. Life Expectancy. [ONLINE] available at: http://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-mana-hauora-tutohu-health-status-indicators/life-expectancy. Accessed 9th March 2016.
  17. Chelluri L, Pinsky MR, Donahoe MP, Grenvik A (1993) Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 269:3119–3123.
  18. Le Maguet P, Roquilly A, Lasocki S, Asehnoune K, et al. Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med. 2014; 40(5):674–82.
  19. McDermid RC, Stelfox HT, Bagshaw SM. Frailty in the critically ill: a novel concept. Crit Care. 2011; 15(1):301.
  20. Kim S, Han H, Jung H, et al. Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA surg. 2014; 149(7):633–640.
  21. Marik PE. Should age limit admission to the intensive care unit? Am J Hosp Palliat Care. 2007; 241:63–66.
  22. Somme D, Maillet JM, Gisselbrecht M, Novara A, et al. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med. 2003; 2912:2137–2143.


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