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Characteristics, outcomes, and complications among nonagenarian and centenarian patients admitted to the intensive care unit: a scoping review

Critical Care volume 29, Article number: 112 (2025) Cite this article

Abstract

Introduction

Nonagenarians and centenarians are a growing and vulnerable groups of patients admitted to ICU. There is limited information on their characteristics, outcomes, and complications.

Methods

We performed a scoping review of studies focused on nonagenarians and centenarians admitted to ICU. We assessed their characteristics, the presence of frailty, the presence of comorbidities, their complications, their ICU and hospital length of stay and mortality and their long-term outcomes.

Results

We assessed 36 studies, mostly retrospective, with one classified as a National Quality Registry study and another as a prospective analysis of two large multinational cohorts. The studies involved 16,859 patients with a mean age of 92.4 years and a male prevalence of 39.3%. Multiple comorbidities were present in the majority of patients. Overall, 40.7% of patients received mechanical ventilation, with a median of 36% (range: 0%–100%; IQR: 23.8%–50%). Mean duration of mechanical ventilation was 90.4 h, with a median of 84 h (range: 10–221 h; IQR: 12.25–146.5 h). Cardiovascular and renal complications were common. Mean ICU stay across studies was 5.4 days, with a median of 5 days (range: 0.9–13 days; IQR: 2.55–7.03 days). The median length of hospital stay was 12.4 days (range: 5.7–31 days; IQR: 11–17.6 days). The median hospital mortality was 25.55% (range: 0%–62.5%; IQR: 15%–35.5%). The mean six-month and 1-year mortality rates were 38.6% and 45.6%, respectively.

Conclusions

Nonagenarians and centenarians admitted to ICU are a highly comorbid and vulnerable population who experience prolonged hospital stays and complications. However four out of five survive to hospital discharge and half are alive at one year after admission. Therefore, through judicious patient selection, ICU care can be both meaningful and beneficial. Our findings underscore the need for a standardized reporting structure for nonagenarians and centenarians admitted to the ICU to allow comparability across studies, enhanced data quality and reliability, greater research efficiency, and better identification of the unique health needs in this vulnerable patient cohort.

Background

In recent decades, advancements in healthcare, improved living conditions, and better disease management have significantly increased life expectancy, resulting in an exponential increase in the population of nonagenarians and centenarians [1, 2]. In 2015, the global nonagenarian population reached 16.3 million, and is expected to nearly double to 30.9 million by 2030 [3].

Alongside this demographic shift, the proportion of nonagenarians undergoing elective surgeries has increased, driven by medical advancements, particularly in surgery and anesthesia [4]. Despite these advancements, the surgery-related mortality rate in nonagenarians remains high, with nearly one-third of nonagenarians dying during high-risk elective surgery and up to 38% dying during emergency procedures [5]. Postoperative complications frequently occur, with rates reaching up to 60% after major surgery [5].

The exponential growth in the population of nonagenarians and centenarians has led to a more than threefold increase in referrals for patients aged 90 years with certain conditions in recent years [6], increasing the demand for intensive care unit (ICU) bed days among these patients [7]. This demographic shift poses unique challenges for healthcare systems, particularly in ICU settings, where specialized care and tailored approaches are essential.

Although several studies have explored the growing population of nonagenarians and centenarians, their distinct health characteristics [8,9,10,11,12,13,14,15,16,17], and their increasing use of ICU services [6, 7], data remain limited on several key aspects. Understanding the characteristics, outcomes, and complications of these patients is crucial for improving clinical practices and guiding the development of healthcare policies. Specifically, data on mortality rates, length of ICU stay, discharge outcomes, and quality of life post-ICU are essential for evaluating treatment efficacy and optimizing care strategies for nonagenarians and centenarians. Furthermore, identifying common complications and their contributing factors can help refine ICU practices and improve patient safety.

Accordingly, this scoping review systematically analyzed peer-reviewed articles related to “nonagenarians,” “centenarians,” “ICU,” and related terms to identify critical knowledge gaps and guide future research on ICU admissions in this aging demographic.

Study objectives

This scoping review aimed to map the current understanding of the characteristics, outcomes, and complications experienced by nonagenarians and centenarians admitted to ICUs. Specifically, we evaluated the following nine key areas:

  1. 1.

    Patient population and characteristics

  2. 2.

    Sources of ICU admission

  3. 3.

    Reported frailty indices and risk stratification tools

  4. 4.

    Prevalence of common comorbidities

  5. 5.

    Medical and surgical procedures during the ICU admission

  6. 6.

    Incidence and types of complications

  7. 7.

    Length of hospital and ICU stay

  8. 8.

    ICU, hospital, 30-day, and 1-year mortality rates

  9. 9.

    Readmission rates and discharge destinations

  10. 10.

    Patient-reported outcome measures (PROMS) or patient-reported experience measures (PREMS)

Material and methods

Study methodology

This scoping review adhered to the relevant components of the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review Protocols (PRISMA-ScR) guidelines [18] ensuring a systematic and rigorous approach to reviewing the existing literature. The Population, Concept, Context (PCC) framework was utilized to define the scope and structure of the review during the planning phase using a PCC framework [19] for defining the scope and structure of the review during the planning phase. Additionally, the methodological framework combined Braun and Clarke’s inductive-deductive approach [20] with the scoping review process outlined by Arksey and O’Malley [21], further refined and extended by Levac and colleagues [22].

Search strategy

Medline (OVID interface), Excerpta Medica Database (OVID interface), and the Cochrane Central Register of Controlled Trials (Cochrane Library) were searched for eligible published studies. Additional literature was obtained after reviewing the references of relevant studies. Literature search strategies were developed using medical subject headings and text words associated with older patients admitted to ICUs (Supplementary Table 1).

Types of studies and eligibility criteria

Primary empirical research studies were eligible for inclusion, while editorials, protocols for planned studies, abstracts, and dissertations were excluded. Table 1 summarizes the patient inclusion and exclusion criteria and the types of evidence that were included and excluded. All studies and publications reporting data on patients aged ≥ 90 years were included, from an unlimited timeline to 31st August 2024. Capturing all available studies ensures a comprehensive synthesis across decades, allowing for the investigation of temporal trends and the evolution of clinical practices. Older literature provides valuable insights into historical practices, facilitating comparisons with current approaches and identifying improvements and ongoing challenges in mortality rates and resource utilization. Our eligibility criteria included studies reporting on nonagenarians and centenarians admitted to critical care settings, including critical care settings, such as ICUs, critical care units, and coronary care units/cardiac care units. Admissions to emergency departments, nursing homes, rehabilitation facilities, and non-critical hospital wards without a critical illness indication or invasive monitoring and organ support were excluded.

Table 1 Review of the eligibility criteria for the nonagenarian and centenarian population, context, concept, and types of evidence
Full size table

Abstracts not written in English were excluded from the review. For abstracts that met the eligibility criteria, but the full manuscript was not published in English, the manuscript was translated into English for inclusion in the review. While focusing on English-language sources may introduce bias and limit generalizability to non-English-speaking regions, this approach is acceptable for a scoping review, which is not intended to inform evidence-based practice.

Study selection and screening procedures

The review was conducted using the online systematic review platform, Covidence. The screening process involved two stages. Initially, two study reviewers (LW and JMS) independently evaluated the titles and abstracts for eligibility. A pilot test was conducted on performed on a random sample of 50 articles using the pre-defined eligibility criteria to enhance screening reliability. The kappa statistic was then calculated to assess inter-rater agreement for study inclusion [23]. The kappa values were interpreted as follows: ≤ 0 indicated no agreement, 0.01–0.20 indicated slight agreement, 0.21–0.40 indicated fair agreement, 0.41–0.60 indicated moderate agreement, 0.61–0.80 indicated substantial agreement, and 0.81–1.00 indicated almost perfect agreement. A kappa value of 0.8–0.90 (indicating strong agreement) was used as the predetermined threshold for acceptance. Any disagreements were resolved through discussion and, if necessary, by involving a third reviewer (NR), who identified discrepancies and updated the data-charting form accordingly.

Two reviewers (LW and JMS) retrieved and independently screened the full-text articles of all relevant and potentially relevant studies, with a third reviewer (NR) resolving any discrepancies. Studies that did not meet the inclusion criteria were excluded. To ensure study feasibility and adherence to our data collection instruments, and to identify potential issues or gaps in the scoping review protocol, pilot testing was conducted on the initial 50 studies. This process allowed the research team to familiarize the protocol procedures. The inclusion and exclusion criteria were refined to ensure consistent application. The reasons for the exclusion of studies were documented following full-text assessment. A PRISMA flowchart illustrated the entire screening process.

Data extraction

All studies that met the inclusion criteria were organized into a specially designed data extraction form to ensure that all relevant details were captured. The process was carried out independently by two reviewers (LW and JMS), with any disagreements addressed through consultation with a third reviewer when necessary.

Data synthesis and analysis

Data analysis was performed using a statistical software (StataCorp 2023 Stata Statistical Software, version 18; College Station, Texas, USA: StataCorp LLC). Descriptive statistics were used to present the results. Data were reported as counts (proportions), medians (interquartile ranges), and ranges (from minimum to maximum values). The study characteristics were illustrated using both tables and graphs, with a narrative summary provided in the text. Where appropriate, inferential statistical methods were applied to evaluate the likelihood of observed differences between the groups. Research gaps were identified by conducting a comparative analysis of both study and participant characteristics.

For qualitative data concerning quality-of-life outcomes, thematic analysis was employed based on Braun and Clarke’s inductive-deductive approach. This analysis sought to uncover recurring themes and patterns associated with how ICU admissions influence the quality of life among nonagenarians and centenarians and the implications for healthcare resources. These findings highlight the similarities and differences in the selection criteria for nonagenarians and centenarians admitted to ICUs, and the risk stratification processes used during hospital and ICU stays. Specifically, this review assessed current individual, institutional, and system-level quality of care indicators for nonagenarians and centenarians admitted to ICU settings.

Patient and public involvement

This review analyzed existing research studies and did not involve patients or members of the public.

Results

Study selection

The search strategy resulted in the screening of 738 articles, with an additional 40 identified through a gray literature search and reference tracking. A total of 264 full-text publications and conference proceedings were assessed for eligibility, resulting in the inclusion of 36 studies in the review. Figure 1 presents a PRISMA flow diagram detailing the selection of these studies.

Fig. 1
figure 1

PRISMA flowchart showing the study selection process

Full size image

Study characteristics

The review included all studies published in English between 1993 and 2024. All 36 studies had a retrospective design, comprising 33 full-text journal articles and 3 full-text conference proceedings. Among these, 35 were single-nation studies, while one was a multinational study. Table 2 presents the baseline study characteristics and outcome measures.

Table 2 Summary of the study characteristics of the publications included in the review
Full size table

Risk of bias within studies

All 36 studies were retrospective cohort studies. According to the SIGN cohort study checklist [60], all studies were classified as having an “acceptable quality” due to their adherence to clear and focused research questions; however, none demonstrated “high-quality” evidence. Detailed results of the risk of bias assessment are provided in Supplementary Table 2.

Study population and patients characteristics

The review included 16,859 patients aged ≥ 90 years admitted to ICUs, critical care units, or cardiac care units, with an average of 39.3% men and a mean age of 92.4 years across the cohort. While most studies included patients aged ≥ 90 years, only Hogan et al. [46] specifically focused on centenarians, with others grouping them within the broader ≥ 90 years category without separate outcome analysis. Ten publications [36, 39, 40, 42, 49, 52, 55,56,57,58] reported an average BMI of 23.5 kg/m [2]. However, none of the publications provided detailed sociodemographic data.

Primary sources of ICU admission

Thirty studies [25,26,27,28,29,30,31,32,33,34,35,36, 38,39,40,41, 43,44,45,46, 48,49,50,51,52,53,54,55, 57, 58] reported the rates of primary ICU admission, which were then classified into three categories: medical, unplanned surgical, and planned surgical. Twenty one publications [26,27,28,29,30, 33, 38,39,40,41, 43,44,45, 48,49,50,51, 53, 55, 57, 58] reported the medical admission rates, with mean and median values of 60.1% and 60% (range: 16.7–100; IQR: 45%–75%), respectively; 19 reported the rates of planned surgical admission to ICUs [25, 27, 28, 31, 32, 34,35,36, 38, 40, 45, 46, 50,51,52, 54, 55, 57, 58], with median values of 37.8% (range: 5.7%–100%; IQR: 31.35%–100%), respectively; and 11 reported the rates of unplanned or emergency surgical admission [27, 28, 38, 40, 45, 50, 51, 53, 55, 57, 58], with median values of 22% (range: 6.3%–50%; IQR: 15.5%–29.9%), respectively.

Thirteen studies [27, 31, 32, 34,35,36, 39, 42, 44,45,46, 49, 54] provided data on the sources of ICU admission. The four most frequent sources were hospital wards, homes, emergency departments, and nursing facilities. Nine studies [27, 31, 32, 34,35,36, 44, 46, 54] identified medical or surgical wards as the primary source, with a mean of 87.9% and a median of 100% (range: 27.8%–100%; IQR: 93.75%–100%). Four studies [27, 42, 44, 45] reported home as the source of admission, with a median of 44.0% (range: 23.3%–86%; IQR: 24.6%–68.8%). Another four studies [42, 44, 45, 49] identified nursing facilities as the source, with a median of 13.7% (range: 9.1%–37%; IQR: 12.3%–19.8%). Additionally, two studies [41, 46] indicated emergency departments as the source of admission, with a mean value of 55.9%.

Supplementary Table 3 summarizes the outcomes of critically ill nonagenarians and centenarians across different ICU types, including medical, surgical, mixed, and cardiac ICUs. Nine studies compared mortality outcomes based on primary admission type [27, 28, 31, 32, 38, 40, 43, 50, 55], revealing the highest rates in medical ICUs, followed by unplanned and planned surgical admissions.

Frailty indices and risk stratification tools

In total, 25 of the studies [24, 26,27,28,29,30, 38,39,40,41,42,43,44,45, 47, 48, 50,51,52,53,54,55, 57,58,59] reported 6 indices and risk stratification tools: the Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE IV the Clinical Frailty Scale (CFS), Sequential Organ Failure Assessment (SOFA), and Charlson Comorbidity Index (CCI). Among these, 11 studies (44%) reported SAPS II [24, 26, 28, 38,39,40,41, 44, 45, 55, 58], 6 (24%) reported APACHE II [27, 29, 30, 39, 43, 50], 1 (4%) reported APACHE IV [51], 8 (32%) reported SOFA [24, 30, 40, 47, 53, 55, 58, 59], and 11 (50%) reported CCI [41, 42, 44, 45, 48, 52, 54, 55, 57,58,59]. Table 3 presents is summary of statistical frailty index and risk stratification tools reported in the studies. The correlation between SAPS II and SOFA scores and ICU mortality rates is illustrated in Fig. 2.

Table 3 Risk stratification tools, comorbidities, interventions and complications of nonagenarians in ICU
Full size table
Fig. 2
figure 2

Correlation between SAPS II and SOFA scores and mortality rates of nonagenarians admitted to the ICU

Full size image

Comorbidities

Thirty-one studies [25, 27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45, 48,49,50,51,52, 54,55,56,57,58,59] evaluated the pre-admission health status and comorbidities of critically ill nonagenarian ICU patients. Table 3 presents the prevalence of common comorbidities, highlighting arterial hypertension as the most frequently reported condition, followed by heart failure and chronic kidney disease. The table provides the median prevalence with interquartile ranges (IQR), along with minimum and maximum values across the included studies. Although these comorbidities were commonly reported, only a few studies explored their association with mortality [27, 36, 38, 39, 43, 45]. However, their impact on patient outcomes remains uncertain.

ICU interventions

Twenty-five publications [26,27,28,29, 36,37,38,39,40,41, 43,44,45, 47,48,49,50,51, 53,54,55,56,57,58,59] reported the use of mechanical ventilation (both invasive and non-invasive methods), with seven detailing the ventilation duration. On average, 40.7% of patients received mechanical ventilation, with a median of 36% (range: 0%–100%; IQR: 23.8%–50%). The median duration of mechanical ventilation was 84 h (range: 10–221 h; IQR: 12.25–146.5 h). Additionally, 22 publications [26, 29, 37,38,39,40,41,42,43,44,45, 47,48,49,50, 53,54,55,56,57,58,59] reported the use of vasoactive agents, 11 studies [38, 40, 41, 43,44,45, 50, 53, 55, 58, 59] documented the use of renal replacement therapy, and five studies [38, 45, 48, 58] reported the use of blood transfusion during ICU admission. Table 3 summarizes the medical and surgical procedures undertaken in the ICU. The association between the proportion of nonagenarians who required postoperative mechanical ventilation and ICU mortality is illustrated in Fig. 3.

Fig. 3
figure 3

Correlation between the reported proportion of nonagenarians admitted to the ICU requiring postoperative mechanical ventilation and the ICU mortality rates

Full size image

Complications

A total of 11 studies [25, 27,28,29, 31, 32, 34,35,36, 52, 54]reported the ICU and postoperative complication rates, with a median overall complication rate of 72.3% (range: 22.0%–94%; IQR: 58.8%–72.3%). Cardiac complications were the most prevalent, affecting one in three patients. Table 3 summarises the most common complications.

Length of ICU and hospital stay

As shown in Table 4, 31 studies [25,26,27,28,29,30,31,32,33,34,35,36, 38,39,40, 42,43,44,45,46,47,48,49,50,51,52,53,54,55, 57, 58] assessed the length of ICU stay, while 25 evaluated the duration of hospital stay [25,26,27,28, 30,31,32, 34,35,36, 38,39,40, 42,43,44,45,46, 49, 51, 52, 54, 55, 57, 58]. The median ICU stay across studies was 5.0 days (range: 0.9–13 days; interquartile range [IQR]: 2.55–7.025 days). The median hospital stay was 12.4 days (range: 5.7–31 days; IQR: 11–17.6 days).

Table 4 Length of hospital and ICU stay in nonagenarians and centenarians
Full size table

Mortality

Most of the included studies assessed the hospital mortality rates. Across these studies, the median mortality was 25.55% (IQR: 15%–35.5%). Of the seven studies [38, 44, 51, 52, 54, 55, 58] that reported a 3-month mortality rate median mortality was 42.1% (IQR: 21%–45.2%). Additionally, seven studies [28, 41, 42, 44, 45, 52, 54] assessed the 6-month mortality rate, reporting a median mortality of 40% (range: 0%–71%; IQR: 18.25%–61.4%). Of the 12 studies [25, 36, 38, 42, 44, 45, 51, 52, 56,57,58,59] reporting 1-year mortality rate, the median mortality was 53.85% (range: 6.7%–77%; IQR: 20.5%–59.7%). Only five studies evaluated the 5-year mortality rate [31, 32, 36, 50, 52] with median mortality of 37.2% (range: 20%–73.5%, IQR: 32.8%–41%). Figure 4 presents a summary of hospital and longer-term mortalities.

Fig. 4
figure 4

Comparison of ICU, hospital, and long-term mortality rates

Full size image

Readmission rates and discharge destinations

Only four studies [27, 31, 37, 54] (11%) reported either the ICU or hospital readmission rate. The median readmission rate was 12% (IQR: 6.8%−17%). In addition, 10 studies [27, 36, 38, 42, 44,45,46, 49, 52, 54] (28%) documented the discharge destinations from the ICU. Six studies [27, 36, 38, 45, 46, 54] identified home as the discharge destination, six studies [36, 45, 46, 49, 52, 54] reported discharge to rehabilitation facilities, four [38, 42, 45, 46] identified discharge to nursing homes and three [27, 44, 45] identified discharge to other hospitals.

Patient-reported outcome measures

None of the studies assessed the patient-centered outcomes, including metrics such as days alive and out of the hospital, quality of life indicators, patient-reported outcome measures (PROMs) or patient-reported experience measures (PREMs).

Discussion

Key findings

We conducted a scoping review of the characteristics, outcomes, and complications among nonagenarian and centenarian patients admitted to the intensive care unit. Comorbidities and frailty were common in this group, though their direct impact on patient outcomes appears limited—likely due to the use of severity indices like APACHE II and SAPS II, which incorporate comorbidities into their overall assessment, potentially overshadowing their independent contributions and leading to underreporting. Cardiovascular and renal complications were observed in more than one in four patients; however, despite a significant proportion of these patients receiving vasopressor therapy or invasive ventilation, approximately four out of five patients survived to hospital discharge, and about half remained alive at one year. These findings align with prior studies across diverse geographic contexts, timeframes, and slightly younger populations, highlighting consistent trends in mortality and predictors of survival in elderly ICU patients. Age remains independently associated with increased mortality in elderly ICU patients [61,62,63], while premorbid conditions and illness severity—assessed using the Clinical Frailty Scale (CFS) and SOFA—further enhance predictions of long-term survival [63].

Moreover, our findings reiterate that whilst nonagenarian and centenarian patients admitted to the ICU frequently present with a significant burden of comorbidities and frailty that complicate their critical care journey, many patients in this age group can achieve excellent outcomes when care is appropriately tailored to their unique health profiles. Whilst ICU mortality rates can be high, ranging from 35 to 60% and even higher in hospital mortality, reaching up to 80% in some studies [64, 65], evidence from this review underscores that, through judicious patient selection, ICU care can be both meaningful and beneficial [66, 67]. Further, results of this review may guide clinical decision-making, not only in identifying candidates for ICU admission, but also in implementing individualized goals of care.

The type of ICU admission—whether medical, unplanned surgical, or planned surgical—significantly influences patient outcomes. Mortality is highest in medical ICU admissions, followed by unplanned and planned surgical admissions. This pattern reflects greater frailty and multimorbidity in medical patients and acute deterioration in unplanned surgical cases, while elective surgeries benefit from preoperative optimization [68]. Understanding these differences is crucial for optimizing ICU resource allocation and tailoring patient management strategies.

However, our findings imply that triage to ICU should be determined by the severity of the illness, functional capacity, and the appropriate limits of care, not only by age alone. Moreover, findings from this review can facilitate the early implementation or withdrawal of interventions, the efficient allocation of hospital resources, and the provision of personalised care plans that can improve clinician decision-making. Additionally, our findings may enable discussions regarding palliative care and encourage the development of more robust multidisciplinary partnerships to comprehensively address the patient’s health.

Knowledge gaps

This review has also identified several key knowledge gaps, notably the predominance of retrospective study designs and the focus on short-term outcomes rather than longer-term recovery and quality of life [67, 69]. Survivors of ICU frequently experience a decline in functional status, and long-term survival remains limited, with few patients returning to pre-admission levels of independence.

While comorbidities are frequently reported in nonagenarian ICU patients, their impact on patient outcomes may be less significant than other factors such as illness severity, frailty, cognitive status, and functional capacity [70]. In this context, complex multimorbidity (CMM) [71], defined as the co-occurrence of three or more chronic conditions across different body systems, offers a more comprehensive understanding of illness burden than the traditional model, which simply counts the number of conditions. CMM, coupled with multiple functional limitations, is increasingly prevalent in older adults and has been linked to poorer outcomes and higher resource use. These insights indicate the need for further studies to explore CMM’s role in this population and develop assessment frameworks that integrate multiple prognostic factors. Furthermore, while CMM offers a valuable lens for understanding the complexity of aging, only one study [46] addresses the characteristics and outcomes of centenarians—a growing and under-researched population—underscoring the need for further exploration to stratify outcomes by age group.

Future research should aim to fill these gaps by conducting prospective studies that investigate interventions to reduce complications, and improve functional outcomes, while incorporating patient-centered metrics such as quality of life and long-term recovery [58, 59]. Implementing a minimum standardized reporting structure for studies on nonagenarians and centenarians in the ICU would provide several advantages, namely, improved comparability across studies, enhanced data quality and reliability, greater research efficiency, and better identification of the unique health needs in this vulnerable patient cohort. Importantly, a standard structure allows for easier longitudinal studies and the tracking of health trends over time within this population, which can inform future healthcare policy and resource allocation. The recommended minimum standardized reporting for nonagenarians and centenarians admitted to the ICU is summarised in Table 5.

Table 5 Recommended minimum standardized reporting for nonagenarians and centenarians admitted to the ICU
Full size table

Strengths and limitations

This study has several strengths. Our review provides a comprehensive overview and descriptions of the characteristics of ICU admissions for nonagenarians and centenarians, including the length of ICU and hospital stay and hospital mortality rates. The diverse range of studies worldwide offers valuable insights into the international outcomes of nonagenarians admitted to the ICU. Our detailed examination of this homogenous patient cohort allows for an in-depth understanding of the clinical characteristics, treatment approaches, and outcomes. These findings provide directions for future research aimed at addressing the existing knowledge gaps and enhancing clinicians’ understanding of the prognostic and risk factors associated with complications and outcomes in nonagenarians and centenarians admitted to the ICU.

This review has some limitations. The exclusive focus on English language sources could introduce bias and affect the generalizability of the findings to non-English-speaking regions; however, the review was intended as a scoping exercise rather than to inform evidence-based practice. The scarcity of publications and the relatively small numbers of patients in many of the included studies imply several key points. First, insufficient data may prevent drawing strong or generalizable conclusions, and the lack of larger studies makes it difficult to establish definite trends or make evidence-based recommendations. Additionally, small sample sizes reported in many studies increase the risk of selection bias, potentially skewing outcomes, or overestimating effects. The inclusion of studies with distinct subpopulations, such as those focusing on specific surgical cohorts, introduces heterogeneity, which has been addressed in our analysis. Furthermore, individual treatment protocols for each ICU remain unknown, and inconsistent and heterogeneous reporting across studies is another limitation, making it difficult to compare results across studies or make definitive conclusions about the effectiveness of treatments, interventions, or post-discharge well-being/status, particularly regarding Quality of Life (QoL) and Activities of Daily Living (ADLs). These limitations highlight a gap in the literature, suggesting the need for larger, more comprehensive studies to address unanswered questions and strengthen the evidence base.

Conclusions

This scoping review identified key risk and prognostic factors that may have a significant impact on patient outcomes in nonagenarians and centenarians. Our finding underscores both age- and non-age-related factors contributing to the increased mortality rates in ICU settings. These insights pave the way for future research, emphasizing critical parameters that warrant further investigation to identify additional risk and prognostic factors. Moreover, the review demonstrates that despite the high rates of hospital, ICU, short-term, and long-term mortality, as well as long ICU and hospital stays among patients aged ≥ 90 years, judicious patient selection can make ICU care both meaningful and beneficial. These results underscore the need for standardized reporting practices for nonagenarians and centenarians admitted to the ICU to ensure consistency and comparability across studies. Additionally, there is an urgent need for demographic-specific, tailored care strategies to improve outcomes in this vulnerable population.

Availability of data and materials

No datasets were generated or analysed during the current study.

Abbreviations

APACHE:

Acute physiology and chronic health evaluation

BMI:

Body mass index

CCI:

CHARLSON comorbidity index

CI:

Confidence intervals

CD:

Clavien-dindo

CFS:

Clinical frailty scale

FFP:

Fresh frozen plasma

HREC:

Human research ethics committee

ICU:

Intensive care unit

IQR:

Interquartile range

LOS:

Length of stay

PRBC:

Packed red blood cells

PROMs:

Patient-reported outcome measures

PREMS:

Patient-reported experience measures

SAPS:

Simplified acute physiology score

SOFA:

Sequential organ failure assessment

SD:

Standard deviation

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Author notes

  1. Je Min Suh and Nattaya Raykageeraroj are first coauthors.

Authors and Affiliations

  1. Department of Anaesthesia, Austin Health, 154 Studley Road, Heidelberg, VIC, 3084, Australia

    Je Min Suh, Boris Waldman & Laurence Weinberg

  2. Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Nattaya Raykageeraroj & Nuanprae Kitisin

  3. Department of Geriatric Medicine, Austin Health, Heidelberg, Australia

    Cilla Haywood

  4. Department of Intensive Care, Austin Health, Heidelberg, Australia

    Cilla Haywood & Rinaldo Bellomo

  5. Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia

    Rinaldo Bellomo & Laurence Weinberg

  6. Department of Cardiology, Austin Health, Heidelberg, Australia

    Anoop N. Koshy

  7. Department of Intensive Care, Alfred Health, Prahran, Australia

    David Pilcher

  8. Department of Anaesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea

    Dong-Kyu Lee

  9. Australian and New Zealand Intensive Care Research Centre, Monash University, Prahran, Australia

    David Pilcher

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Contributions

JMS, NR, BW, NK all were responsible for: Data curation, Literature review, Data analysis, Writing—original draft, Writing—review & editing CH, RB, AN and PP were responsible for: Conceptualization, Methodology, Validation, Visualization, Writing—original draft, Writing—review & editing LW and DKL were responsible for Conceptualization, Supervision, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing—original draft, Writing—review & editing. All authors read and approved the final manuscript.

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Correspondence to Laurence Weinberg.

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Suh, J.M., Raykageeraroj, N., Waldman, B. et al. Characteristics, outcomes, and complications among nonagenarian and centenarian patients admitted to the intensive care unit: a scoping review. Crit Care 29, 112 (2025). https://doi.org/10.1186/s13054-025-05349-z

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Keywords

Critical Care

ISSN: 1364-8535