Guidelines Ethics End of Life Quality and Patient Safety

Guidelines on Caring for Older Adults in the ICU

Lauren E. Ferrante, MD, MHS, ATSF Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM Nathan E. Brummel, MD, MSCI, ATSF

PUBLISHED: 03/20/2026

Guidelines on Caring for Older Adults in the ICU

Citation: Ferrante LE, Chaudhuri D, Laiya Carayannopoulos K, et al. Society of Critical Care Medicine guidelines on caring for older adults in the ICU. Crit Care Med. 2026 Mar. Forthcoming.

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Rationale: Older adults (those 65 years old or greater) compose a substantial proportion of the ICU population. As older adults with critical illness possess unique factors and considerations relevant to their care and outcomes, there is a need for evidence-based recommendations to guide critical care clinicians in the care of older ICU patients.

Objective: The objective of this guideline is to develop evidence-based recommendations addressing the care of older adults during and after critical illness.

Design: The American College of Critical Care Medicine Board convened a 22-member interprofessional panel, comprising physicians, advanced practice providers, nurses, a pharmacist, physical therapist, occupational therapist, and a patient representative. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guideline development including task force selection and voting.

Methods: The panel members prioritized five Population, Intervention, Comparator, and Outcomes (PICO) questions. A systematic review was conducted for each question to identify the best available evidence, synthesize the evidence and assess the certainty of evidence using GRADE. The evidence-to-decision framework was used to formulate recommendations.

Results: The panel generated two conditional recommendations and three “no recommendation” statements. The conditional recommendations are: 1) We suggest a geriatric model of care for all older adults admitted to the ICU and 2) We suggest not using antipsychotic medications for the prevention of delirium in older adults with critical illness. The three “no recommendation” statements are: 1) We make no recommendation regarding specialized post-ICU follow up for older survivors of critical illness, 2) For older adults (age 65 and over) admitted to the ICU with vasodilatory shock, we make no recommendation with regard to targeting a mean arterial pressure (MAP) of 60-65 mm Hg as compared with usual care (MAP target > 65 mm Hg), and 3) We make no recommendation regarding the use of antipsychotic medication in the treatment of delirium in older adults with critical illness.

Conclusions: The guideline panel developed recommendations on caring for older adults during and after critical illness. Areas for future research were also identified during the guideline process.

Guideline Type: Clinical

Related Resources:

	Infographic: De-implementation of Antipsychotics for the Prevention of Delirium in Older Adults
	Visual Abstract: SCCM Guidelines On Caring For Older Adults In The ICU
	Implementation Toolkit: Guidelines for Caring for Older Adults in the ICU
	Interactive Infographic: What Is A Geriatric Model of Care in the ICU?
	Interactive Infographic: Research Priorities: SCCM Guidelines on Caring for Older Adults in the ICU

Read Full Guideline

Identifier:

Strength:

We suggest a geriatric model of care for all older adults admitted to the ICU.
Certainty of evidence: Very low

Conditional Geriatric model of care

We make no recommendation regarding specialized post-ICU follow-up for older survivors of critical illness.
Certainty of evidence: Low

Conditional Post-ICU follow-up

For older adults (age 65 and over) with vasodilatory shock, we make no recommendation with regard to targeting a MAP of 60-65 mm Hg as compared with usual care (MAP target > 65 mm Hg).
Certainty of evidence: Very low

Conditional Mean arterial pressure

We suggest not using antipsychotic medications for the prevention of delirium in older adults with critical illness.
Certainty of evidence: Very low

Conditional Antipsychotic medication

We make no recommendation regarding the use of antipsychotic medication in the treatment of delirium in older adults with critical illness.
Certainty of evidence: Low

Conditional Antipsychotic medication

MAP = mean arterial pressure.

Author

Lauren E. Ferrante, MD, MHS, ATSF

Lauren E. Ferrante, MD, MHS, ATSF, is an associate professor in pulmonary and critical care medicine at the Yale School of Medicine and a core director at the Yale Claude D. Pepper Older Americans Independence Center. She served as cochair on the Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU.

Author

Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM

Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, is an associate professor and physician at McMaster University in Hamilton, Ontario, Canada. He served as cochair on the Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU.

Author

Nathan E. Brummel, MD, MSCI, ATSF

Nathan E. Brummel, MD, MSCI, ATSF, is an associate professor of internal medicine in the Division of Pulmonary, Critical Care and Sleep Medicine at the Ohio State University Wexner Medical Center in Columbus, Ohio, USA. He is board certified in internal medicine and pulmonary diseases. He served as cochair on the Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU.

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