Recherche sur « réanimation et personnes âgées » en France : revue de la littérature et perspectives

To summarize studies on critical care and the elderly in France, in three research areas: proportion of elderly people, vital and functional prognosis, triage decisions. Data sources: “PubMed” database, from 2000 to 2014 ; keywords: “Aged” or “Aged; 80 and over” or “Frail Elderly”; and “France”; and “intensive care unit”; “intensive care”; or “critical care”. Additional search in the journals: Annales françaises d'anesthésie réanimation; Réanimation and Journal européen des urgences. Eligible articles: studying old patients (aged 65 and over) and very old (aged 80 and over) hospitalized in ICU and/or triaged upstream the ICU. Only original studies were included. Extracted and analyzed data: location; designs; objectives; proportion of elderly patients; therapeutic costs; vital and functional prognosis; triage decisions; methodological strengths/limitations. Three hundred and ninety-two articles were identified; 31 were eligible; and 19 were included: 14 in ICUs; 3 in “Smur” (pre-hospital mobile emergency and intensive care units); and 2 in Emergency Departments. Patients aged 80 and older were 10 to 18% of patients in the ICUs. Vital prognosis: mortality rates differed across ICU types; 28 to 62% in hospital; and 70% at 1 year (medical and medico-surgical ICUs). Functional prognosis: results generalisability limited by sampling biases. Triage decisions: ICU admission rate 12% among patients aged 80 and older with at least one criterion for intensive care; inter-hospitals variations unexplained. The ratio of elderly people in the ICUs needs to be clarified at the national level; and monitored to assess the impact of the population ageing. The research agenda should embed multicenter prognosis studies and qualitative studies on determinants of triage decisions.