Aggressive Intensive Care Treatment of Very Elderly Patients with Tetanus Is Justified
Although the incidence of tetanus has steadily declined over the years in industrialized countries, immunity against the disease is lacking or insufficient in more than 65 percent of the elderly population. Consequently, patients over the age of 60 years represent nearly 60 percent of total cases, and while optimal management in intensive care units has decreased mortality to 10 to 15 percent with good long- term recovery, the reported case fatality rate for patients over 60 years remains at approximately 52 percent. Taking into account this last figure as well as the discomfort and potential complications of prolonged sedation, muscle paralysis, and mechanical ventilation, one might question the wisdom of intensive care treatment for elderly patients. Our experience, however, is somewhat different in this respect. To illustrate this, we present herein three case reports of tetanus in patients over 80 years old recently admitted to the Geneva (Switzerland) University Hospital, and review our case series from 1968 to 1989 comparing outcome, length of intubation and hospitalization, and long-term complications between patients younger than and older than the age of 70 years.
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