Severity of baseline frailty is a strong predictor of one-year survival in older adults facing critical illness. It is also key to informing treatment plans and goals of care for these individuals, a new study finds.
Investigators analyzed data from more than 24,000 older adults receiving home care in Ontario who were admitted to an intensive-care unit. Using three different measures for baseline frailty, they found that the most frail intensive care unit survivors had only a 1 in 5 chance of living to one year after discharge.
In general, the odds of mortality rose as severity of baseline frailty increased in participants overall and among the 26% who received mechanical ventilation. What’s more, investigators were better able to predict survival after ICU admission when they adjusted for one of the frailty measures than when they adjusted only for age, sex, major clinical category and area income.
Frailty measures can be useful in conversations about advance care planning with patients and families, according to researcher Luke Andrew Turcotte, Ph.D., of the University of Waterloo, Canada. A frail individual may decide to forgo ICU care, for example, when informed about their prognosis, he explained.
Clinical frailty reduces the ability to maintain or restore physical, physiological or cognitive function when confronted with health stressors, Turcotte noted. Clinicians should emphasize that the condition is clearly distinguished from disability, he and his colleagues added.
“The concept of frailty relates to age-associated vulnerability, and thus its application needs to be limited to older persons with complex health problems,” co-author George Heckman, M.D., concluded.
Full findings were published in CHEST, a journal of the American College of Chest Physicians.
