title: Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study.
abstract: OBJECTIVE
  Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality of life among survivors of critical illness.
  
  
  METHODS
  Prospective multicenter observational cohort study.
  
  
  METHODS
  ICUs in six hospitals from across Alberta, Canada.
  
  
  METHODS
  Four hundred twenty-one critically ill patients who were 50 years or older.
  
  
  METHODS
  None.
  
  
  RESULTS
  Frailty was operationalized by a score of more than 4 on the Clinical Frailty Scale. Health-related quality of life was measured by the EuroQol Health Questionnaire and Short-Form 12 Physical and Mental Component Scores at 6 and 12 months. Multiple logistic and linear regression with generalized estimating equations was used to explore the association between frailty and health-related quality of life. In total, frailty was diagnosed in 33% (95% CI, 28-38). Frail patients were older, had more comorbidities, and higher illness severity. EuroQol-visual analogue scale scores were lower for frail compared with not frail patients at 6 months (52.2 ± 22.5 vs 64.6 ± 19.4; p < 0.001) and 12 months (54.4 ± 23.1 vs 68.0 ± 17.8; p < 0.001). Frail patients reported greater problems with mobility (71% vs 45%; odds ratio, 3.1 [1.6-6.1]; p = 0.001), self-care (49% vs 15%; odds ratio, 5.8 [2.9-11.7]; p < 0.001), usual activities (80% vs 52%; odds ratio, 3.9 [1.8-8.2]; p < 0.001), pain/discomfort (68% vs 47%; odds ratio, 2.0 [1.1-3.8]; p = 0.03), and anxiety/depression (51% vs 27%; odds ratio, 2.8 [1.5-5.3]; p = 0.001) compared with not frail patients. Frail patients described lower health-related quality of life on both physical component score (34.7 ± 7.8 vs 37.8 ± 6.7; p = 0.012) and mental component score (33.8 ± 7.0 vs 38.6 ± 7.7; p < 0.001) at 12 months.
  
  
  CONCLUSIONS
  Frail survivors of critical illness experienced greater impairment in health-related quality of life, functional dependence, and disability compared with those not frail. The systematic assessment of frailty may assist in better informing patients and families on the complexities of survivorship and recovery.
authors: 1Division of Critical Care Medicine (University of Alberta Hospital), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 2Department of Critical Care Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada. 3School of Public Health, University of Alberta, Edmonton, Canada. 4Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 5Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 6EPICORE Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors: Sean M
authors: SM
authors: Bagshaw
authors: H Thomas
authors: HT
authors: Stelfox
authors: Jeffrey A
authors: JA
authors: Johnson
authors: Robert C
authors: RC
authors: McDermid
authors: Darryl B
authors: DB
authors: Rolfson
authors: Ross T
authors: RT
authors: Tsuyuki
authors: Quazi
authors: Q
authors: Ibrahim
authors: Sumit R
authors: SR
authors: Majumdar
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D015897:Comorbidity; D016638:Critical Illness / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D051346:Mobility Limitation; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D012720:Severity of Illness Index; D017741:Survivors / Q000523:psychology*