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.
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
