Intensive care admissions in older adults: are we moving from ageism to ableism?
Abstract
We aimed to study (1) if chronological age still influences ICU admission decisions for older adults; and (2) if and how functional independence and frailty scales are used by clinicians today in France. Chronological age continued to influence ICU admission decisions through references to life expectancy. Functional independence and frailty scales (ADL/IADL and CFS) were used to assess premorbid status, estimate prognosis, and facilitate interprofessional communication. However, scales sometimes functioned as decision-making shortcuts, reduced deliberation, and risked reinforcing self-fulfilling prophecies. Scores were also used to justify implicit value judgments, valuing functionally independent and fit patients who have “successfully aged” and judging others to be less worthy of ICU admission. Though functional independence and frailty scales provide structured support for ICU admission decisions, their use may inadvertently embed normative assumptions about aging and functional independence. Across Europe, the proportion of older adults is increasing, raising complex questions regarding intensive care unit (ICU) admission decisions in late life. As chronological age is no longer recommended alone as an ICU admission criterion, functional independence and frailty have gradually helped refine medical assessment of older adults and guiding decisions. We aimed to study chronological age’s influence in ICU admission decisions and if and how functional independence and frailty scales are currently used in France. We conducted a qualitative study using semi-structured interviews of geriatricians, emergency physicians, and intensivists. Physicians’ decision-making practices in critical situations were discussed. Data were analyzed using inductive thematic analysis within a constructivist and empirical ethics framework. We interviewed 15 geriatricians, 8 emergency physicians, and 9 intensivists. Chronological age continued to influence ICU admission decisions through references to life expectancy. Functional independence and frailty scales (ADL/IADL and CFS) were used to assess premorbid status, estimate prognosis, and facilitate interprofessional communication. However, scales sometimes functioned as decision-making shortcuts, reduced deliberation, and risked reinforcing self-fulfilling prophecies. Scores were also used to justify implicit value judgments, valuing functionally independent and fit patients and judging others to be less worthy of ICU admission. Chronological age continues to shape ICU admission decisions for older adults despite increasing reliance on functional independence and frailty scales. Though these provide structured decision-making support, their use may inadvertently embed normative assumptions about aging and functional independence. Greater reflexivity is needed to ensure patient-centered robust decision-making for older adults in critical care.
Related
- Perceptions of aging and ageism among young adults
- Ageism toward older adults during COVID-19: associations with emotional coping and intergenerational contact
- Early warning signals of sudden changes in daily step count: an intensive longitudinal study of over 20,000 adults
- Illuminating gendered ageism with the WHO ageism experiences scale: a psychometric analysis and gender comparisons in a multi-country dataset.
- Psychometric Validation of the Ageism Scale for the Portuguese Context
BibTeX
@article{moisi2026intensive,
title = {{Intensive care admissions in older adults: are we moving from ageism to ableism?}},
author = {Laura Moïsi and Bénédicte Lombart and Valérie Bellamy and Fabrice Gzil and Jean-Christophe Mino},
journal = {European Geriatric Medicine},
year = {2026},
month = nov,
doi = {10.1007/s41999-026-01468-0},
url = {https://hal.science/hal-05850313v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Intensive care admissions in older adults: are we moving from ageism to ableism?
AU - Laura Moïsi
AU - Bénédicte Lombart
AU - Valérie Bellamy
AU - Fabrice Gzil
AU - Jean-Christophe Mino
PY - 2026
DA - 2026/11/03
JO - European Geriatric Medicine
DO - 10.1007/s41999-026-01468-0
UR - https://hal.science/hal-05850313v1
AB - We aimed to study (1) if chronological age still influences ICU admission decisions for older adults; and (2) if and how functional independence and frailty scales are used by clinicians today in France. Chronological age continued to influence ICU admission decisions through references to life expectancy. Functional independence and frailty scales (ADL/IADL and CFS) were used to assess premorbid status, estimate prognosis, and facilitate interprofessional communication. However, scales sometimes functioned as decision-making shortcuts, reduced deliberation, and risked reinforcing self-fulfilling prophecies. Scores were also used to justify implicit value judgments, valuing functionally independent and fit patients who have “successfully aged” and judging others to be less worthy of ICU admission. Though functional independence and frailty scales provide structured support for ICU admission decisions, their use may inadvertently embed normative assumptions about aging and functional independence. Across Europe, the proportion of older adults is increasing, raising complex questions regarding intensive care unit (ICU) admission decisions in late life. As chronological age is no longer recommended alone as an ICU admission criterion, functional independence and frailty have gradually helped refine medical assessment of older adults and guiding decisions. We aimed to study chronological age’s influence in ICU admission decisions and if and how functional independence and frailty scales are currently used in France. We conducted a qualitative study using semi-structured interviews of geriatricians, emergency physicians, and intensivists. Physicians’ decision-making practices in critical situations were discussed. Data were analyzed using inductive thematic analysis within a constructivist and empirical ethics framework. We interviewed 15 geriatricians, 8 emergency physicians, and 9 intensivists. Chronological age continued to influence ICU admission decisions through references to life expectancy. Functional independence and frailty scales (ADL/IADL and CFS) were used to assess premorbid status, estimate prognosis, and facilitate interprofessional communication. However, scales sometimes functioned as decision-making shortcuts, reduced deliberation, and risked reinforcing self-fulfilling prophecies. Scores were also used to justify implicit value judgments, valuing functionally independent and fit patients and judging others to be less worthy of ICU admission. Chronological age continues to shape ICU admission decisions for older adults despite increasing reliance on functional independence and frailty scales. Though these provide structured decision-making support, their use may inadvertently embed normative assumptions about aging and functional independence. Greater reflexivity is needed to ensure patient-centered robust decision-making for older adults in critical care.
SN - 1878-7657
ER -