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.

Professor Hans Flaatten  is professor in Intensive Care Medicine at Haukeland University Hospital. He was Medical director of the ICU from 1994 to 2004 and now is senior consultant in Intensive Care part time. He was specialist in Anaesthesia and Intensive Care in 1986, and have since mainly worked in Bergen. He has a PhD in medicine from 1998, and was professor in Intensive care Medicine from 2004 at the University of Bergen. In 2013, he was visiting Scholar at the Chinese University in Hong Kong: Prince of Wales Hospital. The main interests in intensive care has been education and training, outcomes after intensive care and quality management. He served as head of the Division of Education and Training in the European Society of Intensive Care Medicine (ESICM) from 2007-2009 and as Chair of the Section of Health Service and Outcome 2009-2012. In 2017 he was awarded honorary membership in ESICM. He was also President for the Scandinavian Society and Intensive care Medicine Congress in Bergen 2011. He has 215 publications on PubMed and  research activity the last years have a focus on the very old patients in the ICU, mainly as PI of the so-called VIP network with around 300 ICUs around Europe and elsewhere conducting large scale collaborative studies in this field.

Professor Bertrand Guidet  is the director of the Medical Intensive Care at the Hôpital Saint Antoine in Paris, France. He gained his Medical Doctors degree in 1985. In 1987, he joined the Medical Intensive Care Board. In 1993 he gained the necessary qualifications to perform research direction. He has been a university medical professor since 1997. Professor Guidet is also a member of the research unit INSERM U1136 at the National Institute for Health and Medical Research (INSERM), which is a French public organization entirely dedicated to biological, medical and public health research. He was medical director of the Est Paris Area group of hospitals from 2011 to 2019. He is the past President (2008-2010) of the French Society for Intensive Care (SRLF) and is currently a member of the Health Research and Services outcome section of the European Society of Intensive Care Medicine (ESICM). In 2019 he was awarded honorary membership in ESICM. Professor Guidet has written 375 articles published in national and international journals. He worked on the critically-ill older patients since almost 20 years and was the PI of several national and international studies.

Doctor Hélène Vallet  work as geriatrician in the acute geriatric centre of Saint Antoine Hospital (Paris) since 2019. She obtained her Medical Doctor degree in 2014 and is specialized in internal medicine and geriatric medicine. She also graduated with PhD in immunology since 2019. Her interest areas are acute stress in older patients notably after intensive care and surgery.

Doctor Hélène Vallet is also a member of the research unit INSERM U1135 at the National Institute for Health and Medical Research (INSERM), and interested since 4 years about the impact of acute stress on senescent immune system. She is member of the French National Society of Geriatrics and Gerontology (SFGG) and of the European Academy for Medicine of Ageing (EAMA).  Doctor Hélène Vallet has written 24 articles published in national and international journals and is co-responsible of a national university diploma about intensive care and anesthesia in older patients at Sorbonne University.

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.