Frailer patients treated in intensive care have a much greater risk of requiring institutional care and dying after being discharged from hospital, regardless of age, according to UK researchers.
They found frail patients were almost twice as likely to die in the year following admission to critical care and even more likely to need nursing home care after discharge from hospital.
“Being frail is associated with poorer outcomes after critical illness”
The researchers noted that frailty was very common, affecting up to one in 10 people over 70 years old, leading to reduced strength and endurance and difficulty carrying out normal daily activities.
It has previously been linked to earlier death, poor function, and increased admissions, but the researchers highlighted that its role in critical care outcomes had been unclear.
In their study, Sheffield University researchers looked at data on 7,732 adults, aged 17 to 104 years old, who were admitted to critical care departments in two of the city’s hospitals over three years.
They measured the effect of frailty on mortality risk in the year after admission at Sheffield Teaching Hospitals NHS Foundation Trust. Smaller samples of patients were also assessed for changes to residence and differences in dependency before and after admission.
Of 7,732 patients 1,726 were considered to be frail with an average age of 72.5 years, based on an assessment of their health and function using the Rockwood frailty score.
Results showed that around 40% of frail patients had died within one year of admission compared to 15% of non-frail patients.
“This study should trigger further research and quality improvement efforts”
Frail patients were at almost twice the risk of dying in the year after admission to critical care compared to non-frail patients, even after accounting for factors like age, the number of organs supported during care and major comorbidities like metastatic disease or kidney failure.
Frailer patients were also nearly 2.5 times as likely to need institutional care and became more dependent after discharge from hospital, the researchers found.
“Our findings suggest that being frail is associated with poorer outcomes after critical illness and this could affect decision making regarding appropriate care by patients, said the study authors.
“This study should trigger further research and quality improvement efforts aimed at improving the care and outcomes of the growing population of frail patients with critical illness,” they added.
The study results were presented as a poster (see attached PDF, below) at this year’s Euroanaesthesia congress in Geneva. The work has yet to be submitted to a journal for publication.