简介

        世界人口中≥60岁者预计将从2013年的12%增加到2050年21%。这相当意味着将有20亿的老龄人口，其中≥80岁者约4亿。随着人口老龄化，ICU也将面临增加对老年人口的护理需求，目前10%-20%的ICU住院患者中为≥80岁者。

        Introduction

        The proportion of the world population aged 60 years or over is expected to increase from 12 % in 2013 to 21 % in 2050 [1]. This increase will represent more than 2 billion elders, including 400 million aged 80 years or over. As the population ages, intensive care units (ICU) are facing an increasing demand for care of the elderly [2], with patients aged 80 or over now representing 10–20 % of all ICU admissions.

        1. The benefit of intensive care is controversial

        1. 老龄患者收住ICU的益处是有争议的

        2. Few elements help ICU triage

        2. 老龄患者的ICU分诊原则内包含的要素并不多

        3. Patients and their relatives should participate in the decision‑making process

        3. 老龄患者及其家属应参与到医疗决策的过程中

        4. An ICU trial may be an alternative

        4. 需要临床研究考查老龄患者收入ICU的效果和结局

        5. Mortality is high in critically ill elderly patients

        5. 老龄重症患者的病死率不低!

        上图中ICU内≥80岁者的病死率15%-25%(B)，院内病死率25%-45%(C),一年病死率70%(D)

        6. A substantial number of patients die early after ICU discharge

        6. 不少老龄患者在ICU转出后即早期死亡(20%)

        7. Few patients have a good recovery at 1 year

        7. 少有老龄患者的1年康复率良好

        8. There are alternatives to ICU

        8. 除了ICU，其实还有其他的单元适合收住老龄重症患者(比如中间ICU或多学科的老年看护病房)

        9. End‑of‑life issues are critical in the elderly

        9. 老龄患者的临终治疗可是大事@ (很多老龄患者被放弃治疗或者医院也未对患者的临终意愿进行登记，实际不好啊老龄患者愿意生命延续治疗，强行制定林中治疗的决策并不合适，也令情况变得复杂)

        10. There is also a social perspective

        10. 社会方面的因素(看看下面的具体文字，我觉得没提到也社会有关的事情。实际是在说老龄加护的需要正在实质性增加并持续中，为了能够让老龄重症监护有可持续性及可负担性，未来将对如何供给并最小化减少对公共卫生支出的影响进行研究)

        Considering the increasing demand for intensive care in elderly and the limited ICU resources, we will face in the near future a critical point where demand for care will be higher than ICU supply. Increased spending on intensive care delivery in the elderly is already underway and will inevitably continue, despite the apparently low rates of good long-term recovery in those patients. In order to give rise to sustainable intensive care services, future research will need to focus on how to provide care to the elderly according to their needs, and with a minimal impact on healthcare expenditures.