Geriatric critical care assessment: key considerations

Abstract

Frailty, multimorbidity, and altered physiology each and together shape the presentation, management, and outcomes for older people with critical illness. This narrative review of the field argues that the structures and processes of geriatric critical care must align with the outcomes that matter to older people living with frailty. This extends the scope of consideration beyond assumptions which may necessarily be restorative or curative, to focus on those interventions which are most achievable and desirable. Frailty is a stronger predictor of mortality, functional decline, and health-related quality of life than age alone. Yet frailty screening changes nothing, unless there is a corresponding change in clinical approach. We review the ABCDE-Frailty framework, operationalising frailty-attuned assessment in standard emergency evaluation using the 5Ms: Mind, Mobility, Medications, Multicomplexity, and Matters most. Person-centred decision-making, incorporating shared value- and goal-based understanding, provides the ethical and clinical foundation for proportionate treatment in critical situations. Avoiding non-beneficial intervention is not therapeutic nihilism but rather its opposite: care directed towards dignity, function, and the outcomes people themselves would choose. A paradigm shift is required, from survival-centred to person-centred, frailty-attuned geriatric critical care.