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Throughout history and even today, the elderly has been treated differently than the rest of the population. In some cultures, they are looked up to and honored both for their knowledge and skills, while in others they are considered of little value, like in the old Viking culture, and are expected to “disappear” when they are considered to be a burden for their tribe. Today, many modern societies practice another form for “disappearance,” that is, the elderly are taken care of by the social welfare system in nursing homes and similar places, and this way, they are often separated from the rest of the family and are less visible to the society.

Cultural differences may also influence the way we meet critically ill elderly patients, and in our “modern world,” it is easy for many to argue that large resources to increase life span in octogenarians could be used in better ways. We have recently observed what happened in the early phase of the COVID-19 pandemic where some countries overwhelmed with too many sick patients opted the “easy” way out: to use age alone as a criterion for ICU admission and treatment.

It is easy to understand why; when using a pure utility approach for ICU triage, the elderly will always loose. As a group, their expected life span will constantly be shorter than less-old patients. However, expanding these considerations into daily life without pandemic can be perilous.

We have written and edited this book since we hope to increase the awareness of a group within our ICUs that deserves to be taken seriously. The old patients will increase more than any other ICU sub-populations across the world in the coming 30–40 years. Without appropriate preparation now, we will end up with a constant “crisis” using ad hoc solution instead of doing some fundamental changes.

We sincerely believe that many critically ill old patients deserve to be given optimal care. There is no uniform evidence that intensive care is futile for the majority, although we also acknowledge that it is in many elderlies’ interest to refrain from intensive care.

The target audience of this book is primarily the practicing intensivist who regu­larly sees elderly ICU patients admitted, which in fact is most of us. As with other patients, it is important to give timely and adequate care to the critically ill elderly patients, and we hope this book will give the reader new knowledge on how to pro­vide such care. This may vary from full support, similar to most other ICU patients, but sometimes also to accept that offering palliative care is the best option. We believe that emergency physicians might be interested, since they propose old patients for an ICU admission. This is in fact the first triage step that is largely unknown to ICU physicians. Geriatricians might also be another target since they are involved in post-ICU care.