Impact of Frailty on Intensive Care Unit Outcomes

Frailty is not the same as aging.  Frailty may be a more reliable indicator of vulnerability than chronological age alone. Frail individuals may experience catastrophic multisystem organ failure from illnesses that are tolerated by non-frail individuals of the same age. This can lead to the need for advanced life support in an intensive care unit (ICU) setting. There is growing evidence that frailty is a common end-of-life trajectory that extends hospital and ICU stays.

Frailty is characterized by a decrease in physiologic reserves, making one more vulnerable to adverse events.1,2  The risk of frailty is increased by individual chronic diseases or their co-occurrence. Multiple comorbidities are common among the patients we manage.  The focus should move from single-condition patient populations to patient populations that are increasingly complex.3  Risk factors for frailty include multi-morbidity, polypharmacy, depression, education, social isolation and loneliness.  Frailty is not linked to age, chronic comorbidities, or disability.  Frailty exists on a spectrum. Failure to thrive is often seen as the end stage of the continuum of frailty.  The mortality rate among patients with this condition is high and their chance of returning home is much lower than that of typical ICU patients. ICU clinicians need to recognize that the risk of in-hospital mortality can rapidly change during the initial 2 weeks of an ICU course.  The objective measurement of frailty can provide more support and reinforcement to clinicians when making decisions about the appropriateness of ICU support and/or withholding life-sustaining therapies at the end of life.4,5,6

Frailty, a clinical syndrome that is characterized by significant vulnerabilities due to declining reserve and function across multiple physiologic systems, is common in the elderly.7 This study contributes to the growing evidence base that ICU survivorship places a substantial burden on families and carers, including impaired physical function, neuropsychological sequelae, increased health care costs and reduced health-related quality of life.8  As a result, these patients require rehabilitation.9