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. 2014 Jun;29(3):401-8.
doi: 10.1016/j.jcrc.2013.12.019. Epub 2014 Jan 6.

The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors

Matthew R Baldwin  1 , M Cary Reid  2 , Amanda A Westlake  3 , John W Rowe  4 , Evelyn C Granieri  5 , Hannah Wunsch  6 , Thuy-Tien Dam  7 , Daniel Rabinowitz  8 , Nathan E Goldstein  9 , Mathew S Maurer  10 , David J Lederer  11
Affiliations

The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors

Matthew R Baldwin et al. J Crit Care. 2014 Jun.

Abstract

Purpose: To determine whether frailty can be measured within 4 days prior to hospital discharge in older intensive care unit (ICU) survivors of respiratory failure and whether it is associated with post-discharge disability and mortality.

Materials and methods: We performed a single-center prospective cohort study of 22 medical ICU survivors age 65 years or older who had received noninvasive or invasive mechanical ventilation for at least 24 hours. Frailty was defined as a score of ≥3 using Fried's 5-point scale. We measured disability with the Katz Activities of Daily Living. We estimated unadjusted associations between Fried's frailty score and incident disability at 1-month and 6-month mortality using Cox proportional hazard models.

Results: The mean (SD) age was 77 (9) years, mean Acute Physiology and Chronic Health Evaluation II score was 27 (9.7), mean frailty score was 3.4 (1.3), and 18 (82%) were frail. Nine subjects (41%) died within 6 months, and all were frail. Each 1-point increase in frailty score was associated with a 90% increased rate of incident disability at 1-month (rate ratio: 1.9, 95% CI 0.7-4.9) and a threefold increase in 6-month mortality (rate ratio: 3.0, 95% CI 1.4-6.3).

Conclusions: Frailty can be measured in older ICU survivors near hospital discharge and is associated with 6-month mortality in unadjusted analysis. Larger studies to determine if frailty independently predicts outcomes are warranted.

Keywords: Aged; Critically Ill; Disability; Frailty; Mortality.

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Figures

Figure 1
Figure 1
Study subjects.
Figure 2
Figure 2
Plots showing the distribution of Fried’s frailty score as an ordinal variable from 0 to 5 among all subjects. The percentage of subjects are shown above the bars. Fried et al. categorized community-dwelling older adults as robust (score: 0), pre-frail (1-2), or frail (≥ 3) (10).
Figure 3
Figure 3
Kaplan-Meier survival curves from the date of discharge following hospitalization involving intensive care by Fried’s frailty score. No subjects had a frailty score of 0. All subjects with a frailty score of 1 or 2 at hospital discharge survived 6 months. P value represents the p for trend across Fried’s frailty score.
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