Abstract
Population ageing is expected to increase demand for intensive care, yet ICU use among older adults shows divergent trends. Absolute activity, case-mix proportions, treatment days, and population-based incidence can move in different directions. Challenging conventional assumptions about critical care utilisation, we examine the apparent paradox by exploring the potential contribution of healthier ageing, frailty-informed and goal-concordant decision-making, expanded alternative care pathways, and broader epidemiological, ethical, and healthsystem factors in intensive care utilisation.