General Reanimatology · Sep 3, 2026
Impact of Frailty on Outcomes and Management of Older and Very Old Patients in the Intensive Care Unit (Review)
By BAYALIEVA AZ, Рустэмовна ДВ
The aim of this review is to assess the impact of frailty on outcomes in critical illness among older and very old patients, and to summarize current approaches to their management in the intensive care unit (ICU). Materials and Methods. The review included 66 publications from PubMed, Google Scholar, the Cochrane Library, and eLIBRARY.RU. The search was conducted using the keywords «frailty», «older patient in intensive care», «treatment of elderly and senescent patients», «critical conditions in older age», «immunosenescence», «cognitive impairment», and «sarcopenia». Results . We reviewed the processes encompassed by the concept of frailty or «senile asthenia» (SA); tools for assessing SA severity; identified the factors of physiological aging that affect the course of the underlying disease in elderly and senile patients in the ICU; and highlighted the specific features of their treatment approach. Conclusion . A number of physiological aging factors significantly influence the management strategy for the studied ICU patient cohort, including changes in hormonal regulation, immunosenescence, sarcopenia, and altered cognitive function. Comorbidities, medication use patterns, and mobility status should also be taken into account. Frailty leads to higher mortality among older and very old ICU patients compared with patients without SA. For management of frail patients a unified approach is recommended combining a multidisciplinary team and family caregivers to maintain patient’s motivation and adherence to the prescribed treatment.