Critical illness is a life-altering experience for both patients and families. Although patients and families have shared priorities for recovery, they also have unique lived experiences that require individualized attention and validation after critical illness. Patient and family needs are dynamic and evolve over successive phases of critical illness recovery. In general, patients and families desire structured, proactive supports that address distinct informational, emotional, appraisal, instrumental, social, and spiritual needs. Timely, consistent, and clear communication across all phases of recovery is key to fostering trust and resilience. The “Timing-it-Right” framework is a useful model to guide recovery-oriented care programs from the hospital ward to community setting. Critical illness recovery programs should be holistic, coordinated, and prioritize functional goals and quality of life. Future research on critical illness recovery should engage diverse patient and family perspectives and incorporate quality of life outcomes that matter to patients and families. Common themes in patient and family experience may provide guidance for clinicians, researchers, and health systems looking to support critical illness recovery.

Beyond the demographic factors of socio-economic disadvantage, inequality and unemployment, some occupations have been historically linked with higher rates of suicide deaths. These include: the armed forces, farmers, healthcare workers (including doctors), and “blue light” emergency workers, or “first responders,” for example, police, ambulance, rescue and fire personnel. Where available, the chapter draws upon systematic reviews and meta-analyses to discuss the evidence in specific occupational groups; the risk indicators and protective factors for suicide at individual, organisational and systemic level; and potential interventions over the course of a worker’s career. Understanding occupational risk factors over the career span from recruitment, self-selection and selection, through work environments and cultures, occupational trauma and stresses, could yield strategies for more generalisable suicide prevention at a population level as well as reducing rates in specific occupations.

The arguments of this book are intended to tackle the social injustices faced by people living with dementia, yet reflecting on the author’s social position reveals a tension. As the author is not a member of the social group this book concerns, they are engaging in an act of speaking for others: a practice that has received significant criticism, given the risks of contributing to oppression and stigma through misrepresentation. With this concern in mind, this chapter engages in a reflective exercise about the content of the book, highlighting ways in which the author’s social position may have negatively influenced its content and setting out the steps the author has taken to try to address this.

While much of this book has been focused on describing post-intensive care syndrome (PICS) in objective terms, is if often the personal stories of survivors of critical illness and their loved ones that are so much more revealing than the distance walked during 6 minutes or a score on a cognitive test. It was not until I began seeing patients in my ICU follow-up clinic that I truly appreciated how life-changing an experience surviving critical illness could be. Understanding the real-life impact of the physical, functional, cognitive, psychiatric, and social impairments that those suffering from PICS face is a profoundly moving and motivating experience. For that reason, I wanted to close this book with stories of survivors of critical illness and their loved ones, allowing the reader to synthesize and contextualize the objective data that has heretofore been presented in neatly parsed, individual chapters and to more deeply appreciate how that data translates into a much more impactful lived experience.

Effective post-ICU recovery requires empathetic exploration of the ICU experience and a detailed evaluation of the unique challenges and symptoms faced by survivors of critical illness. Utilizing palliative care techniques in this evaluation helps clinicians identify unmet needs and coordinate post-ICU management around patient-centered goals. Several palliative care tools and techniques may be used by ICU follow-up clinic providers without specialized palliative care training. Screening tools like the Edmonton Symptom Assessment Scale and Palliative Performance Scale may help clarify post-intensive care syndrome (PICS) symptoms and prognosis, while communication techniques like Ask-Tell-Ask and NURSE emotional response statements may offer insight into patient values and expectations in the post-ICU setting. The implementation of primary palliative care techniques in ICU follow-up clinics may additionally aid in the completion of documents like Advance Directives, which help clarify patient wishes. Specialized palliative care referral may be considered in situations with unmet needs, such as severe physical symptoms, existential distress, and prognosis less than one year. Integration of palliative care principles into the evaluation and management of PICS may ultimately facilitate meaningful recovery in survivors while fostering the concept of post-traumatic growth after critical illness.

In both philosophical research and public discourse around dementia, issues of power and social status receive insufficient attention. The Introduction sets out how this book is aimed at filling this gap.

Cardiac arrest survivorship is a burgeoning phenomenon, largely driven by advances in intensive care and widespread public health campaigns aimed at improving resuscitation outcomes. However, the specific risk factors, mediators, and effective interventions that support long-term survivorship and recovery remain insufficiently understood and are the focus of ongoing research. Survivors of cardiac arrest face multifaceted challenges that affect various aspects of health, including physical, cognitive, psychological, and social well-being. Psychological distress, cardiac anxiety, and the stability of the family unit following cardiac arrest emerge as key factors influencing recovery. Targeted interventions that address the distinct phases of critical illness and recovery following cardiac arrest are crucial and warrant further investigation and implementation.

Survivors of critical illness are at risk for severe negative health outcomes, including an increased risk for mortality in the first several years following their index hospitalization and an increased risk for hospital readmission. recovery trajectories among survivors of critical illness vary considerably, with some patients recovering to near baseline functional status and others entering a cycle of readmissions, disease exacerbations, and prolonged chronic critical illness. Moreover, critical illness has been found to be associated with an increased risk of the development of new chronic diseases, including cardiovascular, pulmonary, neuroloigcal, and renal diseases, as well as worsesning of pre-existing chronic conditions. Given these increased risks, it is no wonder that survivors of critical illness–many of whom may spend more time in a hospital-like setting than at home–have high rates of healthcare utilization. Recognizing these risks can provide a basis for early diagnostic testing and referral for specialty care as needed. Understanding the association of critical illness with subsequent mortality, chronic illness, and healthcare utilization can provide a foundation for the skilled care of survivors of critical illness.

Understanding the financial implications of intensive care unit (ICU) survivor care is critical to the success of ICU follow-up clinics. The model of value-based healthcare first suggested by Porter and Teisburg in their 2006 book, Redefining Health Care: Creating Value-Based Competition on Results, presents a perspective from which to argue for the importance of ICU follow-up clinics. A robust understanding of the financial implications of ICU follow-up clinics must go beyond billing and collections generated by these clinics and should focus on total value provided by these clinics to patients. A general equation to assess value is value = quality / cost. Cost should include not only cost to providers or payors but also to patients and their families. We present a series of practical financial considerations when developing a follow-up clinic that focus on the value attained relative to the costs of running the clinic. We also suggest areas that would benefit from further research, such as optimal staffing, alignment of time frame for resolution of post intensive care syndrome with time points at which the value of follow-up clinics is assessed, and application of behavioral economics to ICU survivor follow-up care process design.

Physiatrists are physicians with specialized training in management of disability, rehabilitation, and restoration of function. Physiatrists work with a multidisciplinary team to achieve the best possible functional outcome after a patient has survived a critical illness or injury. Multiple complications of Post-Intensive Care Syndrome (PICS), such as ICU acquired weakness, spasticity, and the development of contracures and chronic pain syndromes, can be managed by a physiatrist. Physiatrists perform procedures to reduce spasticity and injections to manage pain. Physiatrists also perform gait assessmentts, evaluations for assistive devices or wheelchairs, and assessments to facilitate return to work via vocational rehabilitation.

This chapter presents a case study of the post-intensive care syndrome that highlights some of the syndrome’s defining features: the breadth of disability across physical, cognitive, and psychiatric domains; the duration of disability despite appropriate rehabilitative interventions; the varying degrees of disability over time with the potential for recrudescence, particularly with additional episodes of acute illness; and the social ramifications of the syndrome. This case report also demonstrates the holistic approach taken in ICU follow-up clinics and many of the interventions that such a clinic can provide.