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J Crit Care. 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.

Author information

1
Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: mrb45@columbia.edu.
2
Division of Geriatrics, Weill Cornell Medical Center, New York, NY.
3
Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY.
4
Department of Health Policy, Mailman School of Public Health, Columbia University, New York, NY.
5
Division of Geriatric Medicine and Aging, College of Physicians and Surgeons, Columbia University, New York, NY.
6
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY.
7
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
8
Department of Statistics, Columbia University.
9
Division of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, and Clinical Centers at the James J. Peters VA Medical Center, New York, NY.
10
Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY.
11
Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.

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

PMID:
24559575
PMCID:
PMC4012557
DOI:
10.1016/j.jcrc.2013.12.019
[Indexed for MEDLINE]
Free PMC Article

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