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Review
. 2021 Oct 4;193(39):E1525-E1533.
doi: 10.1503/cmaj.210652.

Optimizing care for critically ill older adults

Olivia Geen  1 , Bram Rochwerg  2 , Xuyi Mimi Wang  2
Affiliations
Review

Optimizing care for critically ill older adults

Olivia Geen et al. CMAJ. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1:
Figure 1:
Potential impact of pre-existing frailty on outcomes after minor and major illness. The green line represents the medical course of an individual who is not frail (Clinical Frailty Score [CFS] 1–3, independent with basic and instrumental activities of daily living [BADLs and IADLs]): a minor illness may cause a transient reduction in physical or cognitive function, but the individual recovers to baseline. A major illness requiring admission to intensive care may cause substantial reduction in function and impairment in ADLs, but a patient who is not frail may improve close to baseline by 6 months. The yellow line represents the medical course of an individual with mild frailty (CFS 4–5): a minor illness may cause a disproportionate reduction in function, and the individual may not return to baseline. A major illness requiring admission to intensive care may cause further substantial reduction in function, from which the individual recovers only partially by 6 months. The orange line represents the medical course of an individual with moderate to severe frailty (CFS 6–8): a minor illness is likely to cause further disproportionate reduction in already limited function without return to baseline, and a major illness is likely to result in substantial reduction in function that does not improve by 6 months, assuming the individual is able to survive the index critical illness (in-hospital mortality for CFS 8 is reported at 48%, and 12-month survival for CFS 6–7 is 35%37). Note: ICU = intensive care unit.
Figure 2:
Figure 2:
The Clinical Frailty Score (CFS) can be used to summarize the overall clinical status of a patient based on comorbidities, activity level and functional impairment. Through conversations with the patient, family or other reliable informant, clinical judgment is used to determine which category best fits the patient. It is recommended that the score be based on the patient’s status 2 weeks before admission to an intensive care unit (ICU) (reproduced with permission: Rockwood et al.28).
Figure 3:
Figure 3:
Components of post–intensive care syndrome (PICS). Survivors of the intensive care unit (ICU) may experience cognitive, physical and mental health impairments. Family members may also experience mental health impairments after the care of a loved one in the ICU.
See this image and copyright information in PMC

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