Academic Journal
End-of-life decision-making in very old critically ill patients.
| Τίτλος: | End-of-life decision-making in very old critically ill patients. |
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| Συγγραφείς: | Sviri S; Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Ein Karem, Israel. sigals@hadassah.org.il., Nagata I; Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.; Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan., Szczeklik W; Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland., Sprung CL; Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. |
| Πηγή: | European geriatric medicine [Eur Geriatr Med] 2026 Aug; Vol. 17 (4), pp. 1771-1781. Date of Electronic Publication: 2026 Jun 12. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer International Publishing Country of Publication: Switzerland NLM ID: 101533694 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1878-7649 (Print) Linking ISSN: 18787649 NLM ISO Abbreviation: Eur Geriatr Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2018- : Cham : Springer International Publishing Original Publication: Issy-les-Moulineaux, Paris : Elsevier Masson SAS |
| Ιατρικοί όροι (MeSH): | Terminal Care*/ethics , Terminal Care*/methods , Terminal Care*/psychology , Critical Illness*/therapy , Withholding Treatment*/ethics , Decision Making*/ethics, Humans ; Aged, 80 and over ; Intensive Care Units ; Decision Making, Shared ; Frail Elderly ; Prognosis |
| Περίληψη: | End-of-life decision-making in the intensive care unit (ICU) is ethically complex, particularly for very old patients with limited physiological reserve. Decisions to limit life-sustaining treatment are shaped by medical prognosis, patient values, cultural and socioeconomic contexts, and uncertainty regarding outcomes. Non-beneficial treatment refers to interventions unlikely to provide meaningful benefit while imposing additional burden or suffering, and avoiding such treatment is central to high-quality end-of-life care. Limitation of life-sustaining treatment may involve withholding or withdrawing therapies, which are distinct from euthanasia, and should be accompanied by a transition toward comfort-focused care. Frailty, pre-illness functional status, and illness severity are key determinants of outcomes and treatment decisions in very old ICU patients. Large international studies, including the VIP, VIP2, and COVIP cohorts, demonstrate that frailty is strongly associated with mortality, functional decline, and treatment limitation, while revealing substantial regional variation in end-of-life practices. Prognostication remains imprecise, often leading to prolonged aggressive care despite poor long-term outcomes. Shared decision-making, grounded in transparent communication and alignment with patient goals, is the ethical standard but is frequently undermined by discordance between documented preferences and delivered care. When decision-making capacity is lost, in the majority of countries shared decision-making extends to surrogate decision-makers, who often experience emotional burden and limited accuracy in predicting patient preferences. Ongoing, structured conversations, meticulous documentation, and time-limited trials of intensive therapy can support iterative reassessment of goals of care. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Conflict of interest: The authors declare no competing interests. |
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| Contributed Indexing: | Keywords: End-of-life; Palliation; Shared-decision-making; Very old; Withdrawing; Withholding |
| Entry Date(s): | Date Created: 20260612 Date Completed: 20260911 Latest Revision: 20260913 |
| Update Code: | 20260913 |
| PubMed Central ID: | PMC13562335 |
| DOI: | 10.1007/s41999-026-01518-7 |
| PMID: | 42286398 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1878-7649 |
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| DOI: | 10.1007/s41999-026-01518-7 |