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Slightly elevated mortality in nonagenarians highlights the need for individualized ICU care guided by more than age.  

Researchers conducted a retrospective study published in June 2025 issue of Annals of Intensive Care to evaluate outcomes and prognostic uncertainty in individuals aged 90 years or older (nonagenarians) admitted to intensive care units (ICUs).  

They reassessed the 30-day mortality risk in nonagenarians admitted to ICUs using data from the VIP1, VIP2, and COVIP registries. Bayesian statistical methods, including Markov Chain Monte Carlo (MCMC) simulations, were applied to estimate the relative risk (RR) of mortality compared to individuals aged 80–89 years (octogenarians). Emotional, personal, and cultural factors can have a significant influence on treatment decision-making for very elderly patients. The analysis incorporated various prior assumptions, including non-informative, pessimistic, and skeptical priors. Adjustments were made for Sequential Organ Failure Assessment (SOFA) score, frailty, and treatment limitations.  

The results showed that 8,408 individuals were included, comprising 807 nonagenarians and 7,601 octogenarians. The 30-day mortality was 45% in nonagenarians and 42% in octogenarians (P= 0.12). Bayesian analysis indicated a high probability (81.1–97.9%) of increased 30-day mortality risk in nonagenarians. The likelihood of a clinically significant increase (RR > 1.1) ranged from 28.9% to 34.7%, while the probability of a substantial increase (RR > 1.2) was minimal (0.03–1.9%).  

Investigators concluded that nonagenarians admitted to ICUs had a marginally higher 30-day mortality risk than octogenarians, though the increase was unlikely to be clinically significant, supporting the need for individualized decision-making beyond age alone. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01496-2