Critical care of the very old, what needs to be done?

Demographic change in the general population is resulting in an increasing number of old patients being recruited into intensive care units. This is a challenge for the ICU team but also for the whole hospital and society. Patients may come from the emergency department (ED), the operating theatre, the wards, or the emergency ward. Admission policy for old patients should be discussed at the hospital level and not merely with the ICU unit. This interdisciplinary and interprofessional approach is mandatory to adapt the hospital for the future. To address several key questions, we decided to launch a series of articles devoted to critical care of the very old. Intensivists and geriatricians discuss some important topics that may have relevance for the field of geriatric intensive care: admission criteria including how coping with prognosis uncertainty, geriatric assessment, impact of comorbidities, optimization of drug prescription, end of life decision, care pathways through intermediate care units, optimization of the patient trajectory after ICU discharge and some specific situations, such as trauma and post-operative care. Collaboration between geriatricians and intensivists is important at every step of the process and must be developed in the future.