Improving long-term trajectories in very old survivors of intensive care: a narrative review.

RESEARCH QUESTION: How can recovery trajectories after critical illness in very old ICU survivors be better understood and potentially modified across the continuum of care? MAIN FINDINGS: Recovery trajectories in very old ICU survivors are highly heterogeneous and result from the interaction between baseline vulnerability (frailty, multimorbidity, social factors), the acute stress of critical illness, and individual resilience. Opportunities to influence these trajectories exist at multiple stages, including prehabilitation before ICU admission,brain- and neuromuscular-protective strategies during ICU stay, and structured, transdisciplinary post-ICU follow-up. CONCLUSION: A shift from survival-focused metrics to a trajectory-based, transdisciplinary approach is essential to improve functional recovery and quality of life in very old ICU survivors.