This book, part of the European Society of Intensive Care Medicine (ESICM) textbook series, provides detailed up-to-date information on the care of the critical ill very old ( 80 years) patients in the ICU.

The very old are expanding fast in our populations, and this is mirrored in our hospitals and ICUs as well. During the last decade, a lot more information about the group of critical ill elderly has been published, and several large networks cooperate in performing multinational studies in this field, one of them with roots in the ESICM. This book will give readers knowledge about the current epidemiology of elderly ICU patients, in  patients centered outcomes and factors affecting these outcomes. A large part is devoted to age related changes in vital organ functions, and the specific geriatric "syndromes" like frailty, cognitive decline, reduced activity of daily living, sarcopenia and immunosenecence. This is all important for the practicing intensivists to know about. In addition, specific groups of the elderly in the ICU are also described like the elderly patients with trauma or sepsis.

The book is written jointly by intensivists and geriatricians, often working in teams and originating from many different countries. This herald a new era in the collaboration between these two groups in order to improve care and rehabilitation. We have a lot to learn from each other, as both groups have a holistic view of our patients although with different perspectives.

This book should be of value for all working in adult ICUs, physicians as well as nurses. It will hopefully lead to a better understanding of the particular challenges posed by this important sub-group of ICU patients and how to manage his group in a way that combine respect for life as well as death and includes patients and caregivers in this process.

Part 1. Introduction: the very old ICU patients

Chapter 1. The demography of ageing and the very old critical ill patients
Chapter 2. Objectives of ICU management for very old patients
Part 2. Age-related physiological changes
Chapter 3. Aged related physiological changes CNS function
Chapter 4. Age-related physiology changes- cardiovascular function in the very old critically ill patient.-  Chapter 5. Age-related changes physiological changes
Chapter 6. Immunological changes
Chapter 7. The Very Old Critically Ill Patient
Part 3. Geriatric syndroms
Chapter 8. Multimorbidity
Chapter 9. MULTIPHARMACY ON THE OLDER ADULT
Chapter 10. Sarcopenia: an overview
Chapter 11. Geriatric syndromes: Frailty
Chapter 12. The Very Old Critically Ill Patients.-  Chapter 13. Functional status and older age
Chapter 14. Comprehensive Geriatric Assessment (CGA)
Part 4. Triage
Chapter 15. Pre-ICU triage - The very old critically ill patient
Chapter 16. Decision-making under resource constraints
Chapter 17. Risk scores for the very old, achievable?
Part 5. Usual ICU procedures
Chapter 18. Ventilation
Chapter 19. Vasoactive drugs
Chapter 20. Acute KidneyInjury and Renal Replacement Therapy in the Very Old Critically Ill Patient
Chapter 21. Sedation and analgesia
Chapter 22. Nutrition
Part 6. Withhold and withdraw therapy
Chapter 23. Limitation of life-sustaining treatments
Part 7. Outcomes after intensive care
Chapter 24. Outcomes after intensive care: Survival
Chapter 25. Outcomes after intensive care: Functional Status
Chapter 26. Cognitive Disorders: outcomes after intensive care
Chapter 27. Rehabilitation
Chapter 28. The Caregiver
Part 8. Specific diseases & conditions
Chapter 29. Acute Respiratory Failure
Chapter 30. Sepsis in older adults
Chapter 31. Chapter Acute Kidney Injury.-  Chapter 32. Neuro intensive care
Chapter 33. Postoperative patients: planned surgery
Chapter 34. Post-operative patients: urgent surgery
Chapter 35. DELIRIUM
Chapter 37.Logistic Challenges and Constraints in Intensive Care during a Pandemic
Part 9. Future developments
Chapter 37. Future challenges for geriatric intensive care.