Table 3.

Recommendations for decision-making about limiting LST in very old patients

Problem	Recommendations
Decision-making under uncertainty	Specify uncertainty (survival, functional outcome), explore potential to quantify uncertainty, establish multidisciplinary meetings and ethics ward rounds
Uncertainty about short-term outcome	Develop framework for (time-limited) ICU trial [67]
Uncertainty about potential for rehabilitation and long-term functional outcome	Consultations with geriatricians, treatment trial in rehabilitation according to the patient's phenotype [67–69]
Uncertainty about burden of therapy and benefit of outcome for the individual patient	Communicate with next-of-kin, caregivers and primary care teams to elicit patient's values and preferences [70], monitor patient's comfort
Knowledge gaps regarding survival and functional outcome in very old patients, absence of specific guidelines	Foster research and training based on international (multi-cultural) collaborations, seek advice from experts outside intensive care [45]
Variations in values and preferences among patients and healthcare professionals	Develop sensitivity to cultural differences, seek mediation and legal advice in case of divergent opinions, support advanced care planning