Background
Methods
Study design, participants and setting
Frailty definition
Outcomes
Data collection and management
Statistical analyses
Results
Factors associated with frailty among nonelderly patients
Variable | Frail (n = 55, 28 %) | Nonfrail (n = 142, 72 %) |
p Value |
---|---|---|---|
Age, years, mean ± SD | 58.9 ± 4.1 | 58.4 ± 4.2 | 0.444 |
Sex, female, n (%) | 28 (50.9) | 44 (31.0) | 0.009 |
Widowed, n (%) | 4 (7.3) | 7 (4.9) | 0.504 |
Education, n (%) | 0.039 | ||
Less than secondary school | 14 (25.5) | 17 (12.0) | |
Secondary school | 23 (41.8) | 58 (40.8) | |
Higher-level degree | 18 (32.7) | 67 (47.2) | |
Employment status, n (%) | |||
Full-time | 9 (16.4) | 50 (35.2) | 0.010 |
Part-time | 1 (1.8) | 15 (10.6) | 0.045 |
On disability | 28 (50.9) | 31 (21.8) | <0.001 |
Prehospital residence, n (%) | <0.001 | ||
At home (independent) | 23 (41.8) | 123 (86.6) | |
At home (with help) | 26 (47.3) | 18 (12.7) | |
Other | 6 (10.9) | 1 (0.7) | |
CSHA Function Scale score (n, %) | |||
Eating (independent) | 51 (92.7) | 142 (100) | 0.006 |
Dressing (independent) | 47 (85.5) | 141 (99.3) | <0.001 |
Personal care (independent) | 45 (81.8) | 142 (100) | <0.001 |
Walking (independent) | 35 (63.6) | 134 (94.4) | <0.001 |
Getting out of bed (independent) | 40 (72.7) | 141 (99.3) | <0.001 |
Taking bath (independent) | 37 (67.3) | 140 (98.6) | <0.001 |
Using toilet (independent) | 49 (89.1) | 140 (98.6) | 0.007 |
Using telephone (independent) | 52 (94.5) | 142 (100) | 0.021 |
Going shopping (independent) | 25 (45.5) | 133 (93.7) | <0.001 |
Preparing own meals (independent) | 29 (52.7) | 138 (97.2) | <0.001 |
Doing housework (independent) | 26 (47.3) | 132 (93.0) | <0.001 |
Taking medicine (independent) | 40 (72.7) | 133 (93.7) | <0.001 |
Managing own finances (independent) | 46 (83.6) | 138 (97.2) | 0.002 |
Elixhauser comorbidity score, mean ± SD | 8.7 ± 9.1 | 6.6 ± 7.6 | 0.098 |
Hypertension | 26 (47.3) | 73 (51.4) | 0.602 |
Heart failure | 10 (18.2) | 9 (6.3) | 0.012 |
Diabetes mellitus | 18 (32.7) | 31 (21.8) | 0.112 |
Chronic kidney disease | 13 (23.6) | 23 (16.2) | 0.225 |
Rheumatoid/connective tissue disease | 20 (36.4) | 13 (9.2) | <0.001 |
Any cancer | 5 (9.1) | 16 (11.3) | 0.657 |
Alcohol/drug abuse | 16 (29.1) | 50 (35.2) | 0.414 |
Psychosis | 3 (5.5) | 4 (2.8) | 0.401 |
Depression | 18 (32.7) | 38 (26.8) | 0.405 |
Prescription medications, n, mean ± SD | 8.8 ± 6.2 | 5.1 ± 4.3 | <0.001 |
Hospitalization in preceding 1-year period, mean ± SD | 34 (61.8) | 46 (32.4) | <0.001 |
Variable | Adjusted OR (95 % CI) |
p Value | % contribution |
---|---|---|---|
Sex | 3.8 | ||
Male | 1 | ||
Female | 2.01 (0.87–4.66) | 0.103 | |
Elixhauser comorbidity score, mean ± SD | 0.96 (0.91–1.02) | 0.213 | 1.6 |
Rheumatoid/CTD | 6.00 (2.12–17.0) | 0.001 | 19.7 |
Heart failure | 3.28 (0.78–13.7) | 0.104 | 1.8 |
Prehospital residence | 49.3 | ||
At home (independent) | 1 | ||
At home (with help)/other | 4.40 (1.75–11.1) | 0.002 | |
On disability | 2.11 (0.83–5.35) | 0.117 | 4.1 |
Managing own finances (independent) | 0.24 (0.05–1.24) | 0.088 | 3.5 |
Never married | 0.23 (0.03–1.56) | 0.133 | 2.8 |
Education | 1.7 | ||
Less than high school | 1 | ||
High school | 0.76 (0.23–2.50) | 0.653 | |
Higher-level degree | 0.53 (0.16–1.75) | 0.296 | |
Prescription medications, n, mean ± SD | 1.01 (0.93–1.10) | 0.748 | 0.1 |
Prior hospitalization | 3.29 (1.34–8.10) | 0.010 | 11.7 |
Association between frailty and clinical course among nonelderly patients
Variable | Frail | Nonfrail |
p Value |
---|---|---|---|
ICU diagnostic category, n (%) | 0.284 | ||
Sepsis | 10 (18.2) | 15 (10.6) | |
Cardiovascular | 5 (9.1) | 20 (14.1) | |
Respiratory | 22 (40.0) | 45 (31.7) | |
Gastrointestinal/liver | 9 (16.4) | 25 (17.6) | |
Othera
| 9 (16.4) | 37 (26.1) | |
ICU admission source, n (%) | 0.900 | ||
Ward transfer | 17 (30.9) | 41 (28.9) | |
OR theater transfer | 13 (23.6) | 39 (27.5) | |
ED | 14 (25.5) | 40 (28.1) | |
Otherb
| 10 (18.2), 1 (1.8) | 20 (14.1), 2 (1.4) | |
Postoperative, n (%) | 13 (23.6) | 55 (38.7) | 0.046 |
APACHE II score, mean ± SD | 19.8 ± 6.7 | 17.9 ± 7.4 | 0.103 |
SOFA score, mean ± SD | 8.2 ± 4.0 | 7.0 ± 4.1 | 0.086 |
Mechanical ventilation, n (%) | 52 (94.5) | 120 (84.5) | 0.058 |
Vasoactive medications, n (%) | 33 (60.0) | 72 (50.7) | 0.241 |
Renal replacement therapy, n (%) | 6 (10.9) | 21 (14.8) | 0.478 |
Preferences for support, n (%) | 0.069 | ||
Full ICU support | 48 (87.3) | 134 (95.0) | |
Limitations on therapy (DNR order) | 7 (12.7) | 7 (5.0) | |
Mortality, n (%) | |||
ICU | 6 (10.9) | 10 (7.0) | 0.390 |
Hospital | 11 (20.0) | 20 (14.1) | 0.306 |
90-day | 13 (23.6) | 21 (14.8) | 0.140 |
6-month | 16 (29.1) | 25 (17.6) | 0.075 |
1-year | 18 (32.7) | 29 (20.4) | 0.069 |
ICU length of stay, days, median (IQR) | 6 (3.5–11.5) | 6 (3–10) | 0.383 |
ICU readmission, n (%) | 9 (18.4) | 18 (13.6) | 0.427 |
Hospital length of stay, median (IQR) | 26 (9–68) | 18.5 (10–43) | 0.389 |
Hospital readmission, n (%) | 26 (60.5) | 49 (40.2) | 0.022 |
Discharge disposition, n (%) | 0.112 | ||
Living at home independent | 14 (32.6) | 62 (50.8) | |
Living at home with help | 16 (37.2) | 31 (25.4) | |
Other | 13 (30.2) | 29 (23.8) | |
EQ-5D-VAS, 6-month | |||
Mean (SD) | 58.8 (18.7) | 63.4 (20.4) | 0.254 |
n (%) | 34/39 (87.2) | 96/117 (82.1) | |
EQ-5D-VAS, 1-year | |||
Mean (SD) | 63.0 (20.2) | 68.3 (17.6) | 0.184 |
n (%) | 28/37 (75.7) | 85/113 (75.2) | |
MCIDc in EQ-5D-VAS between 6 and 12 months, n (%) | 10/27 (37.0) | 29/77 (37.7) | 0.95 |
EQ-5D, 6-month, n (%) | |||
Mobility | 25 (71.4) | 40 (41.2) | 0.002 |
Self-care | 11 (31.4) | 8 (8.2) | 0.001 |
Usual activities | 30 (85.7) | 65 (67.7) | 0.041 |
Pain/discomfort | 30 (85.7) | 54 (55.7) | 0.002 |
Anxiety/depression | 19 (54.3) | 36 (37.1) | 0.077 |
Association between frailty and mortality among nonelderly patients
CFS category | Unadjusted HR | 95 % CI |
p Value | Adjusted HRa
| 95 % CI |
p Value |
---|---|---|---|---|---|---|
Fit (CFS score 1-3) | 1.0 | – | – | 1.0 | – | – |
Vulnerable (CFS score 4) | 3.67 | 1.55–8.69 | 0.003 | 2.89 | 1.19–7.02 | 0.019 |
Mild frailty (CFS score 5) | 2.82 | 0.95–8.38 | 0.063 | 2.54 | 0.82–7.90 | 0.107 |
Moderate to severe frailty (CFS score 6–8) | 4.93 | 1.91–12.73 | 0.001 | 4.41 | 1.62–12.06 | 0.004 |
Association between frailty and nonfatal outcomes among nonelderly patients
Association between frailty and health services use among nonelderly patients
Discussion
Main findings
Context with prior literature
Implications for clinicians and future research
Limitations
Conclusions
Key messages
-
Frailty was common among younger ICU patients, being present in an estimated one-fourth of those aged 50–64.9 years.
-
Frail patients aged 50–64.9 years were more likely to be female, to have greater comorbid illness (in particular connective tissue disease), and to have impaired baseline function and disability.
-
Frail patients aged 50–64.9 years were more likely to have been hospitalized in the 1-year period preceding ICU admission.
-
Frail patients aged 50–64.9 years had higher adjusted mortality at 1 year and greater use of healthcare services.