Die Entscheidung für eine ausgedehnte Intensivtherapie ist bei älteren Patienten oft
herausfordernd. Wichtige Prognosefaktoren, die bei der Entscheidungsfindung helfen,
sind Gebrechlichkeit, funktioneller Status und Begleiterkrankungen. Auf Basis einer
interdisziplinär und interprofessionell getroffenen Teamabstimmung können Patienten
bzw. Angehörige das Verhältnis aus Nutzen und Risiko für den Betroffenen herausarbeiten
und eine fundierte Entscheidung treffen.
Abstract
The decision to initiate extended intensive care in older patients is often challenging.
The ethical principles of beneficence and non-maleficence, together with the patient’s
autonomous will, form the foundation of decision-making. Important prognostic factors
include frailty, functional status, and comorbidities. If intensive care treatment
is initiated, it should be started promptly, but with a clearly defined treatment
goal and predefined limitations regarding interventions that should not be undertaken.
If, during the course, the decision is made against curative intensive care, palliative
care should be provided. In situations where the patient’s wishes or prognosis are
unclear and the likelihood of meaningful benefit is low, a time-limited trial of therapy
with predefined evaluation criteria may be appropriate. In any case, interdisciplinary
and interprofessional team discussions help to improve prognostic assessment. Based
on this, patients and their relatives can
engage in shared decision-making to weigh benefits against burdens and to reach an
informed choice.
Schlüsselwörter
Geriatrische Patienten - Alter - Intensivstation - Patientenverfügung - Shared Decision
Making - Gebrechlichkeit - Frailty - Patientenwille - Autonomie - Prognose - Therapiebegrenzung
Keywords
frailty - Intensive Care Unit - very old patients - shared decision making - prognosis
