The role of frailty in outcomes from critical illness

Abstract

Frailty is a multidimensional syndrome characterized by loss of physiologic reserves that gives rise to vulnerability to adverse events. Frailty has been described in older patients undergoing geriatric assessment and in noncardiac and cardiac surgical settings, in which it closely correlates with heightened risk for major morbidity including functional decline, postoperative complications, institutionalization, and short-term and long-term mortality. Critically ill patients may represent a population with similar vulnerabilities to older frail patients. Prior data have described the association with less favorable outcomes and poor premorbid functional status (i.e., activities of daily living, cognitive impairment, body mass index), used perhaps as a surrogate for frailty. Preliminary epidemiologic data suggest the prevalence of frailty (and intermediate frail states) among critically ill patients is high and likely to increase with the greater demand placed on ICU resources associated with population demographic transition. The concept of frailty, as a marker of biologic age and physiologic reserve, may have direct relevance to critical care, and clearly identifies a population at greater risk of adverse events, morbidity, and mortality. Its recognition in critical care settings may enable improved prognostication and shared decision-making and identify vulnerable subgroups with specific needs who might benefit from targeted follow-up.