Outcomes in Critically Ill Patients Aged 90 Years and Older: A Scoping Review

Abstract

The growing population of nonagenarians has led to increased intensive care unit (ICU) admissions among elderly patients. However, evidence on their outcomes and optimal management strategies remains limited and fragmented. This scoping review aimed to explore mortality outcomes, factors associated with mortality, and treatment intensity in nonagenarians, comparing them to younger patients. A systematic search of MEDLINE and Embase from 1946 to September 2024 identified studies reporting ICU, in-hospital, and long-term mortality in nonagenarians. Twenty-nine studies involving 21,420 nonagenarians and 244,323 younger patients were included. ICU mortality among nonagenarians ranged from 1.42% to 66.7%, with an overall rate of 17.05% (2,738/16,062). In-hospital mortality ranged from 5.6% to 47%, with an overall rate of 26.54% (5,563/20,962). Long-term (one-year) mortality varied from 19% to 77%, with an overall rate of 53.45% (7,020/13,134). Key predictors of mortality included comorbidities, high severity scores (APACHE II, SAPS II), and less aggressive treatment. Despite these factors, nonagenarians had comparable mortality rates to younger patients when adjusted for illness severity. Nonagenarians in ICUs display variable but acceptable mortality rates, suggesting that age alone should not determine care intensity. Their heightened vulnerability after discharge calls for more effective and personalized post-ICU and post-hospital discharge care plans to better address their ongoing risks.