Rethinking ICU Care for an Aging Population

For decades, intensive care units (ICUs) have relied on standardized approaches designed to improve outcomes across all patients. But as people over 65 now account for roughly half of ICU patients, clinicians are increasingly recognizing that older adults bring distinct needs that can shape both care and recovery. Sensory impairments, frailty, and age-related conditions can influence how patients experience critical illness in ways traditional ICU models do not always address.

“As a field, critical care used to focus very much on keeping people alive,” says Lauren Ferrante, MD, MHS, associate professor in the Section of Pulmonary, Critical Care and Sleep Medicine at Yale School of Medicine (Yale-PCCSM). “But older adults have unique needs that require us to think differently about how we deliver care.”

That shift in perspective underlies the first-ever clinical practice guidelines on caring for older adults in the ICU, first-authored by Ferrante and published by the Society of Critical Care Medicine. Developed by an interprofessional panel chaired by Ferrante, the guidelines reflect a growing recognition that older adults have distinct risks, priorities, and recovery trajectories.

For example, older adults are more likely to have hearing or vision loss, which can make the ICU feel even more confusing and overwhelming. They are also more likely to be frail, which is associated with worse recovery of function.

“These are things that a 40-year-old may not have that can significantly shape how an older patient experiences critical illness and recovery,” Ferrante explains.

In practice, ICU care has largely followed standard protocols designed to improve outcomes for all patients. While these approaches—such as managing sedation, screening for delirium, and encouraging early movement—are essential, they do not fully account for how age affects recovery. This creates a gap between what ICU care aims to do and what older patients need.

The guidelines seek to close that gap. The 22-member interprofessional panel, composed of experts in the care of older ICU patients, weighed in on five key questions. In response to the first question, the panel recommended a “geriatric model of care,” an approach that places functional recovery at the center of treatment.

This includes reducing medications that can cause confusion, addressing sensory problems early, and adding therapies that help with function, cognition, and independence. It also requires clinicians to think beyond discharge—asking not just whether a patient will survive, but what kind of life they will return to.

That shift, Ferrante emphasizes, cannot rely on geriatricians alone. “We know there aren’t enough geriatricians to care for every older adult in the ICU,” she says. “So the critical care community itself needs to build that expertise and integrate these principles into routine ICU care for older adults.”

At the same time, the guidelines highlight broader challenges in the field. Older adults remain underrepresented in clinical trials, sometimes excluded by arbitrary age cutoffs despite making up a large share of ICU patients. And while geriatric expertise can improve care, it is not widely available, placing greater responsibility on critical care teams to integrate aging-focused principles into routine practice.

As hospitals begin to adopt age-friendly frameworks that emphasize what matters most to patients, Ferrante sees an opportunity to redefine success in the ICU—not simply as survival, but as the ability to recover, function, and live independently after critical illness.

Pulmonary, Critical Care and Sleep Medicine is one of 10 sections in the Yale Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM's website, or follow them on Facebook and Twitter.