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Abstract

Introduction: Frailty is a multi-dimensional syndrome characterized by loss of physiologic reserves that gives rise to vulnerability to adverse events. Our objectives were to determine the prevalence, correlates, and outcomes associated with frailty among adults admitted to intensive care. Methods: Prospective cohort study enrolling 421 critically ill participants at six hospitals across Alberta. Primary exposure was frailty defined by a score of greater than 4 on the Clinical Frailty Scale. Primary outcome was in-hospital mortality. Secondary outcomes included adverse events, 1-year mortality, and quality-of-life. Results: Mean age was 67 ([SD] 10) years, 39% (n=163) were female, and 95% (n=402) were living at home independently or with assistance. Prevalence of frailty was 33% (n=138; 95% CI, 28-38). Frail patients were older, had more co-morbidities and greater functional dependence than non-frail patients. Adverse events were more common in frail patients (39% vs. 29%, p=0.044). In-hospital mortality was higher for frail compared with non-frail patients (32% vs. 17%; adj-odds ratio 1.81; 95%CI, 1.09-3.01; p=0.022), and this difference persisted at 1-year (48% vs. 25%; adj-hazards ratio 1.71; 95%CI, 1.20-2.44; p=0.003). Frail patients were less likely to return home and be independent (31% vs. 67%; p<0.0001) and had significantly lower quality-of-life. Frail survivors had higher re-hospitalization (6% vs. 1%; p=0.019) in the 12-months following enrollment. Conclusions: Frailty is common in older adults admitted to the ICU and identifies a population at greater risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and shared decision-making and identify a vulnerable population that might benefit from follow-up and intervention.