Understanding frailty will lead to better care for older adults

Research found most frail ICU survivors had only a one in five chance of living to one year after discharge.

Ryan Jones, Univeristy of Waterloo July 7, 2021

Frailty is a better predictor than factors such as age when determining how older adults fare one year after receiving critical care.

A team led by researchers from the University of Waterloo analyzed data from more than 24,000 community-dwelling older adults receiving home care in Ontario who were subsequently admitted into an intensive-care unit (ICU).

They applied three different measures for baseline frailty and found that an individual’s level of frailty was linked to survival one year later. The most frail ICU survivors had only a one in five chance of living to one year after discharge.

Clinical frailty is age-related and characterized by a reduced ability to maintain or restore physical, physiological or cognitive functions when subject to health stressors.

“Our results tell us that baseline frailty can help inform treatment plans and goals of care for older persons with critical illness,” said Luke Turcotte, first author and a postdoctoral fellow at Waterloo during this research.

Turcotte stressed that even though frailty levels could be a key measure when determining who will benefit from critical care, it is important to differentiate between frailty and disability, particularly for individuals with chronic and stable disabilities.

“The concept of frailty relates to age-associated vulnerability, and thus its application needs to be limited to older persons with complex health problems,” said senior author George Heckman, a professor in the School of Public Health Sciences and Schlegel-UW Research Chair in Geriatric Medicine at the Research Institute for Aging.

Previous research had analyzed smaller data sets, with similar conclusions. For this study, the researchers used data from interRAI standardized health assessments, used in home care in almost all of Canada and internationally.

The researchers believe the concept of frailty can best be used to guide conversations about advance care planning with home care clients and their families. “For instance, a frail individual may express the wish to forego ICU care given a poor prognosis,” Heckman said. “Additional research should focus on post-ICU functional and quality of life outcomes.”

The paper was co-authored by Luke Turcotte, Ann Alexandra Zalucky, Nathan M. Stall, James Downar, Kenneth Rockwood, Olga Theou, Caitlin McArthur, and George Heckman. It was published in the journal Chest.

Source Univeristy of Waterloo via EurekAlert! AAAS


Baseline Frailty as a Predictor of Survival after Critical Care: a Retrospective Cohort Study of Older Adults Receiving Home Care in Ontario, Canada, Turcotte LA, Zalucky AA, Stall NM, Downar J, Rockwood K, Theou O, McArthur C, Heckman G. Chest. 2021 Jun 14:S0012-3692(21)01114-4. doi: 10.1016/j.chest.2021.06.009. Epub ahead of print. PDF

  Further reading

Impact of Low Muscle Mass and Low Muscle Strength According to EWGSOP2 and EWGSOP1 in Community-Dwelling Older People, Costanzo L, De Vincentis A, Di Iorio A, Bandinelli S, Ferrucci L, Antonelli Incalzi R, Pedone C. J Gerontol A Biol Sci Med Sci. 2020 Jun 18;75(7):1324-1330. doi: 10.1093/gerona/glaa063. Full text

Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map, Welch, V.Mathew, C. M.Babelmorad, P., et al. (2021).  Campbell Systematic Reviews17, e1175. https://doi.org/10.1002/cl2.1175. Full text

The relationships between muscle strength, biomechanical functional moments and health-related quality of life in non-elite older adults, Samuel D, Rowe P, Hood V, Nicol A. Age Ageing. 2012 Mar;41(2):224-30. doi: 10.1093/ageing/afr156. Epub 2011 Nov 28. Full text

The functional demand (FD) placed on the knee and hip of older adults during everyday activities, Samuel D, Rowe P, Nicol A. Arch Gerontol Geriatr. 2013 Sep-Oct;57(2):192-7. doi: 10.1016/j.archger.2013.03.003. Epub 2013 Apr 2. Full text  PDF

The biomechanical functional demand placed on knee and hip muscles of older adults during stair ascent and descent, Samuel D, Rowe P, Hood V, Nicol A. Gait Posture. 2011 Jun;34(2):239-44. doi: 10.1016/j.gaitpost.2011.05.005. Epub 2011 May 31.

Development of physical disability in older adults, Manini T. Curr Aging Sci. 2011 Dec;4(3):184-91. doi: 10.2174/1874609811104030184. Full text

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