Oldest Old With Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Noninvasive Ventilation: 2 Planets Approaching

We read with great interest the article of Spannella et al1 on the predictors of in-hospital mortality and need for post-acute care in acute exacerbation of chronic obstructive pulmonary disease (COPD) in the oldest adults. Furthermore, in our opinion, there are some uncertainties to clarify. The hospitalized oldest old patients represent a very complicated planet for the presence of frailty, the long-term cognitive impairment, the incidence of delirium, the malnutrition, the comorbidities, the problematic decision-making process, the disability, the life expectancy evaluation, the polypharmacy, and the possible necessity of proper social care.