1. Carney, Amy PhD, NP
  2. Issue Editor

Article Content

Elder Issues in the Intensive Care Unit

This issue of Critical Care Nursing Quarterly is devoted to issues surrounding elders while in the intensive care unit (ICU). The elderly, defined as those older than 65 years, are the fastest growing population in the United States, as well as in other countries around the world. By the year 2030, more than 20% of US residents are expected to be 65 years and older compared with 13% in the year 2010. By the year 2034, all of the baby boomers will be older than 70 years. This patient population will require increased numbers of registered nurses with specialized knowledge, as well as technical skills, in ICUs across the country.


The elderly in the ICU face a myriad of challenges. Age-related changes in sight and hearing, decreased resistance to infectious pathogens, and the presence of comorbidities make them a vulnerable population. Giambattista et al in their article "NICHE Recommended Care of the Critically Ill Older Adult," discuss the program used in optimizing health for older adults in hospitals and other health care organizations. Offering resources for families, patients, and clinicians, it focuses on practice standards and training to improve the care of older adults and provides a Geriatric Resource Nurse course to educate nurses in best practices.


Inappropriate prescribing of medication is also a danger in this age group. Weston and Weston examine the strategy to identify medications that may cause adverse effects in the elderly in their article "Applying the Beers and STOPP Criteria to Care of the Critically Ill Older Adult." Many ICU patients are admitted with multiple medications, known as polypharmacy, and these tools are designed to complement clinical judgment in the pharmacological care of this patient group.


Kirksey, McGlory, and Sefcik, noting that 50% of all patients admitted to critical care units are older adults, examine pain in elderly ICU patients. In their article "Pain Assessment and Management in Critically Ill Oder Adults," the authors note that challenges such as cognitive impairment and intubation make the use of an interprofessional team a necessity, including best practices and providing pharmacological and nonpharmacological interventions. The article "Stuck Inside a Cloud: Optimizing Sedation to Reduce ICU-Induced Delirium in Geriatric Patients" by Leon and Lim considers the use of sedation in ICU patients and outlines its relationship to mortality and overall hospital length of stay. Citing the problem of delirium in ICU patients, the authors discuss the key practice guidelines in the Pain, Agitation, and Delirium (PAD) bundle in the care of these patients.


Finoccchiaro and Hook examine malnutrition and undernutrition in the ICU in their article "Enteral Nutritional Support of the Critically Ill Older Adult." The deleterious effect on recovery in conditions that include postoperative complications, wound healing, and decreased muscle strength and function in this already vulnerable group is described. Umberger, Callen, and Brown note the dangers of sepsis and the systems responses that differ in an older population compared with a younger one in their work "Severe Sepsis in Older Adults."


The article "The Perfect Storm: Older Adults and Acute Kidney Injury" by Hain and Paixao discusses acute kidney injury and notes the factors that contribute to danger in the elderly including polypharmacy, the aging kidney, and nephrotoxic medications. The article "Catheter-Related Bloodstream Infections (CR-BSI) in Geriatric Patient in Intensive Care Units" by Chernecky, Macklin, and Blackburn provides a discussion on a major life-threatening complication and cites the need for specialized knowledge for the geriatric patient population in minimizing both risk and mortality.


Abuse of the elderly is a growing problem in the United States, and the ability to identify and intervene in the ICU increases patients' safety and quality of life as outlined by Carney in "Indicators of Abuse in the Elderly ICU Patient." The article "Elderly Trauma" by Holleran emphasizes the great concern related to accidental injury in this age group and provides an overview of trauma common in patients older than 65 years, with a discussion of the financial burden and an increased need for prevention.


The article "After Rescue: The Important of Beers Criteria for Medication Assessment in Older Adults" by Heintz and Buchholz considers the delicate balance between life-saving medications during critical illness and the potential adverse drug reactions that might accompany them if continued after transfer out of the ICU. The Beers Criteria, combined with the provider's clinical judgment, will ensure the safest course of therapy for geriatric patients.


The final article by Mandebvu and Kalman, "The 3 D's, and Newly Acquired Cognitive Impairment: Issues for the ICU Nurse," summarizes the dreaded complications that often are experienced by older patients in the ICU. Delirium, dementia, and depression, the 3 D's, are discussed as cognitive impairments resulting from acute illness and hospitalization.


This is an exciting and timely issue of Critical Care Nursing Quarterly, one that will both inform practice and lead to further discussion on the elderly, the health jeopardies they face, and improved professional clinical care.


-Amy Carney, PhD, NP


Issue Editor