Patients aged 80 and over are among the fastest-growing groups admitted to intensive care, and their care rarely rests on a single decision or a single specialty. Frailty, polypharmacy, and uncertain recovery mean that choices about admission, treatment intensity, and rehabilitation are shared across disciplines.
Outside critical care, evidence links clinician gender to differences in how care is delivered: patients of female physicians have shown better chronic disease control and, in hospital medicine, lower mortality and readmission rates. Consensus recommendations are only as broad as the panel that writes them, and research on such panels has found that seniority, professional role, and gender all influence how much an individual contributes.
Care of the very old critically ill patient is shared across specialties—patients often arrive through the emergency department, are treated in the ICU, and depend on geriatric medicine for what follow. Reflecting this, the European Society of Intensive Care Medicine (ESICM) recently convened an international Delphi process where a steering group of 28 specialists drafted 59 candidate statements covering goals of care, ICU admission, treatment decisions, and post-discharge management. A further 82 experts rated their agreement across two anonymous rounds, and consensus was reached on 48. The panel was predominantly medical (around 85% doctors) and drawn mainly from intensive care, with geriatric and emergency medicine, clinical pharmacy and allied health also represented.
The analysis led by Dr. Nastaran Sharifian and assisted by medical student Ms. Aoife Bates at University of Galway with international collaborators, analyzed the 128 panelists who reported both gender and clinical background (53 female, 75 male), concentrating on the 26 statements that reached only moderate consensus—where opinion diverged most—and comparing agreement scores on a 0–100 scale. What was measured throughout is how strongly panelists endorsed a proposed recommendation: an expression of opinion, not a record of what any clinician does at the bedside. The study was made available online on August 08, 2026, in the Journal of Intensive Medicine .
The dominant finding is agreement. Across the great majority of the proposed recommendations, there was no significant difference between female and male respondents, and in analyses adjusted for provider category and age, independent effects of gender were limited. Interactions between gender and specialty were almost all non-significant, indicating a pattern consistent across intensivists, emergency physicians, and geriatricians. Where differences emerged, they clustered in one place: multidisciplinary input. Female respondents recorded higher agreement on five statements— medication review by a pharmacist, geriatrician, or other specialist (91.9 versus 81.0, P = 0.002), clinical pharmacist involvement (90.4 versus 81.8, P = 0.006), dietitian input to optimize nutrition (93.0 versus 85.6, P = 0.014), speech and language therapy advice (88.9 versus 80.6, P = 0.016), and transfer from the ICU to a geriatric ward where available (86.9 versus 78.7, P = 0.026). Male respondents recorded higher agreement on one: that decisions to limit life-sustaining therapy should be based on expected functional outcome (87.8 versus 81.2, P = 0.045).
The gaps widened when the researchers looked at who agreed emphatically rather than simply agreed: two-thirds of female respondents strongly endorsed dietitian involvement, against 37.8% of male respondents, and for clinical pharmacists, the figures were 54.7% and 27%. Other domains showed no separation at all, including ethics consultation, quality of life as a long-term outcome, and hospital readmissions.
This is an exploratory secondary analysis, to be read as hypothesis-generating. Twenty-six statements were compared without correction for multiple testing, so while six significant results are more than chance alone would predict, most individual differences would not withstand a conservative correction. The groups are small—roughly 51 female and 71 male respondents per statement—so estimates carry wide margins. The recommendations showing differences are those concerning non-physician disciplines, and nursing and allied health professions are predominantly female. Because the analysis adjusted for medical specialty rather than professional role, it cannot fully separate a gender effect from the tendency of practitioners to endorse their own discipline. These are ratings of proposed recommendations, not observations of care delivered.
What the analysis suggests is that stated support for recommendations on collaborative care varied modestly with who was asked, while the broad architecture of the recommendations commanded consensus regardless—indicating, for those convening guideline panels, the need for broad representation. Whether these attitudinal differences translate into measurable differences for patients remains to be tested.
Reference
Title of original paper: Gender differences in healthcare providers’ perceptions of key care priorities for very old patients in intensive care: A secondary analysis of results from ESICM recommendations for the management of very old patients
Journal: Journal of Intensive Medicine
DOI: 10.1016/j.jointm.2026.06.008
About University of Galway
Website: https://universityofgalway.ie/
About Dr. Bairbre McNicholas from University of Galway
Dr. Bairbre McNicholas is a Senior Lecturer in Anaesthesia and Intensive Care Medicine at University of Galway and Consultant Intensivist, Nephrologist and Physician at Galway University Hospitals. Her research spans personalized respiratory support in acute hypoxemic respiratory failure, acute kidney injury, and artificial intelligence in intensive care research. She has led multinational trials and meta-trials of awake prone positioning that informed international guidelines, and is Co-Director of the ESICM Intensive Care Nephrology Pathway, Deputy Chair of the Irish Critical Care Trials Group Executive Committee, and National Clinical Lead for Continuous Renal Replacement Therapy in Ireland's Acute Critical Care Programme.
https://research.universityofgalway.ie/en/persons/bairbre-mcnicholas/
Funding information
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Implementation of the Delphi study on the Welphi platform (www.welphi.com) was funded by the European Society of Intensive Care Medicine (ESICM).
Journal of Intensive Medicine
Observational study
People
Gender differences in healthcare providers’ perceptions of key care priorities for very old patients in intensive care: A secondary analysis of results from ESICM recommendations for the management of very old patients
8-Aug-2026
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for this journal and was not involved in the editorial review or the decision to publish this article.