title: The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors.
abstract: OBJECTIVE
  To determine whether frailty can be measured within 4 days prior to hospital discharge in older intensive care unit (ICU) survivors of respiratory failure and whether it is associated with post-discharge disability and mortality.
  
  
  METHODS
  We performed a single-center prospective cohort study of 22 medical ICU survivors age 65 years or older who had received noninvasive or invasive mechanical ventilation for at least 24 hours. Frailty was defined as a score of ≥3 using Fried's 5-point scale. We measured disability with the Katz Activities of Daily Living. We estimated unadjusted associations between Fried's frailty score and incident disability at 1-month and 6-month mortality using Cox proportional hazard models.
  
  
  RESULTS
  The mean (SD) age was 77 (9) years, mean Acute Physiology and Chronic Health Evaluation II score was 27 (9.7), mean frailty score was 3.4 (1.3), and 18 (82%) were frail. Nine subjects (41%) died within 6 months, and all were frail. Each 1-point increase in frailty score was associated with a 90% increased rate of incident disability at 1-month (rate ratio: 1.9, 95% CI 0.7-4.9) and a threefold increase in 6-month mortality (rate ratio: 3.0, 95% CI 1.4-6.3).
  
  
  CONCLUSIONS
  Frailty can be measured in older ICU survivors near hospital discharge and is associated with 6-month mortality in unadjusted analysis. Larger studies to determine if frailty independently predicts outcomes are warranted.
authors.affiliation: Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: mrb45@columbia.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Baldwin
authors.affiliation: Division of Geriatrics, Weill Cornell Medical Center, New York, NY.
authors.forename: M Cary
authors.initials: MC
authors.lastname: Reid
authors.affiliation: Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Westlake
authors.affiliation: Department of Health Policy, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: John W
authors.initials: JW
authors.lastname: Rowe
authors.affiliation: Division of Geriatric Medicine and Aging, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Evelyn C
authors.initials: EC
authors.lastname: Granieri
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Thuy-Tien
authors.initials: TT
authors.lastname: Dam
authors.affiliation: Department of Statistics, Columbia University.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rabinowitz
authors.affiliation: Division of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, and Clinical Centers at the James J. Peters VA Medical Center, New York, NY.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Goldstein
authors.affiliation: Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.affiliation: Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
mesh_terms: D018806:APACHE; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D017741:Survivors
keywords: Aged; Critically Ill; Disability; Frailty; Mortality