Frailty in very old critically ill patients in Australia and New Zealand: a population‐based cohort study

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Abstract

To explore associations between frailty (Clinical Frailty Scale score of 5 or more) in very old patients in intensive care units (ICUs) and their clinical outcomes (mortality, discharge destination).

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Most cited references 13

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The APACHE III Prognostic System

Anne Damiano, William A Knaus, Douglas P. Wagner … (1991)

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Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study.

S. Bagshaw, H. T. Stelfox, R. C. McDermid … (2014)

Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserves that confers vulnerability to adverse outcomes. We determined the prevalence, correlates and outcomes associated with frailty among adults admitted to intensive care. We prospectively enrolled 421 critically ill adults aged 50 or more at 6 hospitals across the province of Alberta. The primary exposure was frailty, defined by a score greater than 4 on the Clinical Frailty Scale. The primary outcome measure was in-hospital mortality. Secondary outcome measures included adverse events, 1-year mortality and quality of life. The prevalence of frailty was 32.8% (95% confidence interval [CI] 28.3%-37.5%). Frail patients were older, were more likely to be female, and had more comorbidities and greater functional dependence than those who were not frail. In-hospital mortality was higher among frail patients than among non-frail patients (32% v. 16%; adjusted odds ratio [OR] 1.81, 95% CI 1.09-3.01) and remained higher at 1 year (48% v. 25%; adjusted hazard ratio 1.82, 95% CI 1.28-2.60). Major adverse events were more common among frail patients (39% v. 29%; OR 1.54, 95% CI 1.01-2.37). Compared with nonfrail survivors, frail survivors were more likely to become functionally dependent (71% v. 52%; OR 2.25, 95% CI 1.03-4.89), had significantly lower quality of life and were more often readmitted to hospital (56% v. 39%; OR 1.98, 95% CI 1.22-3.23) in the 12 months following enrolment. Frailty was common among critically ill adults aged 50 and older and identified a population at increased risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and identify a vulnerable population that might benefit from follow-up and intervention.

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Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis

Sean Bagshaw, Steve Webb, Anthony Delaney … (2009)

Introduction Older age is associated with higher prevalence of chronic illness and functional impairment, contributing to an increased rate of hospitalization and admission to intensive care. The primary objective was to evaluate the rate, characteristics and outcomes of very old (age ≥ 80 years) patients admitted to intensive care units (ICUs). Methods Retrospective analysis of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data were obtained for 120,123 adult admissions for ≥ 24 hours across 57 ICUs from 1 January 2000 to 31 December 2005. Results A total of 15,640 very old patients (13.0%) were admitted during the study. These patients were more likely to be from a chronic care facility, had greater co-morbid illness, greater illness severity, and were less likely to receive mechanical ventilation. Crude ICU and hospital mortalities were higher (ICU: 12% vs. 8.2%, P < 0.001; hospital: 24.0% vs. 13%, P < 0.001). By multivariable analysis, age ≥ 80 years was associated with higher ICU and hospital death compared with younger age strata (ICU: odds ratio (OR) = 2.7, 95% confidence interval (CI) = 2.4 to 3.0; hospital: OR = 5.4, 95% CI = 4.9 to 5.9). Factors associated with lower survival included admission from a chronic care facility, co-morbid illness, nonsurgical admission, greater illness severity, mechanical ventilation, and longer stay in the ICU. Those aged ≥ 80 years were more likely to be discharged to rehabilitation/long-term care (12.3% vs. 4.9%, OR = 2.7, 95% CI = 2.6 to 2.9). The admission rates of very old patients increased by 5.6% per year. This potentially translates to a 72.4% increase in demand for ICU bed-days by 2015. Conclusions The proportion of patients aged ≥ 80 years admitted to intensive care in Australia and New Zealand is rapidly increasing. Although these patients have more co-morbid illness, are less likely to be discharged home, and have a greater mortality than younger patients, approximately 80% survive to hospital discharge. These data also imply a potential major increase in demand for ICU bed-days for very old patients within a decade.

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Journal

Title: Medical Journal of Australia

Abbreviated Title: Medical Journal of Australia

Publisher: AMPCo

ISSN (Print): 0025-729X

ISSN (Electronic): 1326-5377

Publication date Created: October 06 2019

Publication date Created: October 2019

Publication date (Electronic): September 05 2019

Publication date (Print): October 2019

Volume: 211

Issue: 7

Pages: 318-323

Affiliations

[1 ]Royal Melbourne Hospital Melbourne VIC

[2 ]Centre for Integrated Critical CareUniversity of Melbourne Melbourne VIC

[3 ]Austin Hospital Melbourne VIC

[4 ]Monash University Melbourne VIC

[5 ]Peninsula Health Melbourne VIC

[6 ]Peninsula Clinical SchoolMonash University Melbourne VIC

[7 ]St Vincent's Hospital Melbourne Melbourne VIC

[8 ]University of Alberta Edmonton AB Canada

[9 ]ANU Medical SchoolAustralian National University Canberra ACT

[10 ]Canberra Hospital Canberra ACT

[11 ]Centre for Health Services ResearchUniversity of Queensland Brisbane QLD

[12 ]The Alfred Hospital Melbourne VIC

[13 ]Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society Melbourne VIC

Article

DOI: 10.5694/mja2.50329

PubMed ID: 31489652

SO-VID: 1dce7944-9cf2-4311-b2d6-01cfedac23be

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Frailty in very old critically ill patients in Australia and New Zealand: a population‐based cohort study

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Most cited references 13

The APACHE III Prognostic System

Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study.

Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis

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