Frailty in the ICU - #45
Take QuizFrailty assessment of patients at time of ICU admission may be useful in identification of vulnerable elderly patients.
Frailty is a chronic, progressive clinical syndrome, characterized by dysregulation of multiple physiologic systems leading to increased vulnerability and mortality.
The presence of ≥3 of the following features correlate with a phenotype of frailty3:
1. Weakness (Decreased grip strength in dominant hand)
2. Exhaustion (Self-reported scale)
3. Weight loss (Unintentional loss of >10 lb. in one year)
4. Slow walking speed (Time to walk 15 feet > 6 or 7 seconds, depending of height < or > 68 inches)
5. Low activity level (<270 kcal/week expenditure)
- The frailty syndrome can be classified as primary (intrinsic to aging process) or secondary (associated to end-stage chronic inflammatory conditions, such as heart failure, COPD, cancer, or HIV infection).4
- The Clinical Frailty Scale (CFS) has been validated as a tool for bedside assessment of frailty: http://www.cmaj.ca/content/173/5/489.figures-only (Box 1)1,6
- A recent multicenter prospective cohort study used a modified 9-point scale to which identify patients with a score > 4 prior to index hospitalization as frail. Frail patients were shown to have [1] increased hospital mortality rates, [2] increased duration in ICU and hospital stays, [3] increased odds of having major adverse events during hospitalization, and [4] increased readmission rates compared to non-frail patients. Further, when compared with nonfrail survivors, frail survivors were more likely to become functionally dependent following critical illness.
- Frailty assessment of patients at the time of ICU admission may be useful in identification of vulnerable patients thereby allowing more accurate prognostication and more informed clinical decision-making.7
Frail elderly patients who are critically ill.
Assess ICU patients for frailty. Assess ICU patients for frailty.
Frailty among the elderly population is found to be as high as 43%, and up to 13% of ICU admissions are of patients over 80 years old. The prevalence of both pre-hospitalization frailty and elderly ICU admissions is increasing, thus increasing the prevalence of frailty in critically ill elderly patients.1,2 Frail patients are more likely to have slow recovery after acute illness, increased fall risk, higher level of functional impairment leading to disability and higher motality.
- Define the frailty syndrome.
- Describe the criteria used to diagnose frailty.
- Use the Clinical Frailty Scale as part of prognostication tools.
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
- McDermid, R.C., Stelfox, H.T., and Bagshaw, S.M. Frailty in the critically ill: A novel concept. Critical Care. 2011; 15:301. http://ccforum.com/content/15/1/301.
- McDermid, R.C. and Bagshaw, S.M. ICU and critical care outreach for the elderly. Best Practice & Research Clinical Anaesthesiology. 2011; 5:439-449.
- Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M156.
- Fried LP. Frailty. Geriatrics Review Syllabus: A Core Curriculum in Geriatrics Medicine. 8th Edition. 2014.
- Bagshaw SM, McDermid RC. The role of frailty in outcomes from critical illness. Curr Opin Crit Care. 2013;19:496–503.
- Rockwood, K., Song, X., Macnight, C., Bergman, H., Hogan, D.B., McDowell, I., and Mitnitski, A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173(5):489-495.
- Bagshaw, S.M., Stelfox, H.T., McDermind, R.C., Rolfson, D.B., Tsuyuki, R.T., Baig, N., Artiuch, B., Ibrahim, Q., Stollery, D.E., Rokosh, E., and Majumdar, S.R. Association between frailty and short- and long-term outcomes among critically ill patients: a multicenter prospective cohort study. CMAJ. 2014; 186(2):E95-E102.
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