The following is a summary of “Frailty, Acute Brain Dysfunction, and Posthospitalization Disability Outcomes in Critically Ill Older Adults,” published in the July 2023 issue of Critical Care by Caldwell et al.
Frailty in older adults is linked with adverse effects in the intensive care unit (ICU), and identifying modifiable factors that mediate these outcomes may help improve survival. Researchers performed a prospective study to estimate the association between frailty, acute brain dysfunction, and 6-month disability outcomes in older adults.
They enrolled older adults (aged ≥50 years) in the ICU. Frailty was identified by the Clinical Frailty Scale. Delirium and coma were assessed daily with the Confusion Assessment Method for the ICU and the Richmond Agitation-Sedation Scale. Disability outcomes (death and severe physical disability [defined as new dependence in 5 or more activities of daily living]) were assessed by telephone (6 months) after discharge.
The results showed 302 older adults (mean [SD] age, 67.2 [10.8] years), both frail and vulnerable patients had a risk of acute brain dysfunction (adjusted odds ratio [AOR], 2.9 [95% CI, 1.5-5.6], and 2.0 [95% CI, 1.0-4.1], respectively) as per fit patients. Both frailty and acute brain dysfunction independently linked with death or severe disability at 6 months (AOR, 3.3 [95% CI, 1.6-6.5] and 2.4 [95% CI, 1.4-4.0], respectively). The average proportion of the frailty effect mediated by acute brain dysfunction was estimated to be 12.6% (95% CI, 2.1%-23.1%; P = .02).
They concluded frailty and acute brain dysfunction independently predict disability outcomes in older adults with critical illness.