Should Very Old Patients Be Admitted to the Intensive Care Units?

I read with great interest the article “Demographic Changes in Intensive Care Units in Korea over the Last Decade and Outcomes of Elderly Patients: A SingleCenter Retrospective Study” published in the Korean Journal of Critical Care Medicine in May 2017 [1]. The results indicated that the proportion of inpatients aged 65–79 years admitted to an intensive care unit (ICU) increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of ICU-hospitalized patients older than 80 years increased from 12.8% in 2005 to 20.7% in 2014. However, the overall mortality rate did not increase despite a higher mortality rate in the elderly than in the younger patients. These results are worthy and impressively demonstrate the recent changing trends in demographic data of ICU patients in Korea. However, I would like to comment on the following two points. First, the authors might have shown a slightly lower sepsis prevalence, not greater than 1% for each subgroup in the ICU. The study conducted by Oh et al. [2], using the Health Insurance Review & Assessment Service database, revealed that the inhospital mortality of patients with sepsis was as high as 38.9%, and the proportion of sepsis increased with age. In addition, in the United States, sepsis was ranked 11 in the top primary diagnoses in 1996 among patients older than 65 years who were admitted to the ICU, but in 2010, sepsis was ranked 1 among the primary diagnoses in older patients admitted to the ICU [3]. In Korea, where the proportion of elderly population is rapidly increasing, it is expected that the rate of primary diagnosis of sepsis in the elderly patients who are admitted to the ICU would be higher. It is considered to be a limitation due to single-center studies, and nationwide demographic studies of ICU patients are required. Second, there had been questions regarding the appropriateness of ICU hospitalization of very old patients (VOPs) aged greater than 80 years with chronic illnesses. Roch et al. [4] reported that among patients older than 80 years, the ICU