title: The Frailty Phenotype and Palliative Care Needs of Older Survivors of Critical Illness.
abstract: OBJECTIVE
  To assess symptoms in older intensive care unit (ICU) survivors and determine whether post-ICU frailty identifies those with the greatest palliative care needs.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Urban tertiary care hospital and community hospital.
  
  
  METHODS
  Medical ICU survivors of mechanical ventilation aged 65 and older (N = 125).
  
  
  METHODS
  Baseline measurements of the Edmonton Symptom Assessment Scale (ESAS), categorized as mild (0-3), moderate (4-6), and severe (7-10), and the frailty phenotype were made during the week before hospital discharge. Functional recovery was defined as a return to a Katz activity of daily living dependency count less than or equal to the prehospitalization dependency count within 3 months. In the last 29 participants recruited, we made additional assessments of fatigue and ESAS both at baseline and 1 month after discharge.
  
  
  RESULTS
  Fatigue was the most-prevalent moderate to severe symptom (74%), followed by dyspnea (53%), drowsiness (50%), poor appetite (47%), pain (45%), depression (42%), anxiety (36%), and nausea (17%). At 1-month follow-up, there were no significant differences in the proportions of participants with moderate to severe symptoms. Each increase in baseline ESAS fatigue severity category was associated with 55% lower odds of functional recovery (odds ratio = 0.45, 95% confidence interval = 0.24-0.84), independent of age, sex, comorbidities, and critical illness severity. Frail participants had a higher median baseline total ESAS symptom distress score (34, interquartile range (IQR) 23-44) than nonfrail participants (13, IQR 9-22) (P < .001).
  
  
  CONCLUSIONS
  Older ICU survivors have a high burden of palliative care needs that persist 1 month after discharge. Fatigue is the most-prevalent symptom and may interfere with recovery. Post-ICU frailty may be a useful trigger for palliative care consultation and a treatment target.
authors.affiliation: Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Pollack
authors.affiliation: Mount Sinai Beth Israel, Division of Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Goldstein
authors.affiliation: Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York.
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Gonzalez
authors.affiliation: Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Blinderman
authors.affiliation: Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York.
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.affiliation: Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.affiliation: Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York.|Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Baldwin
mesh_terms: D016223:Advance Directives / Q000523:psychology; D000359:Aftercare / Q000379:methods; D000368:Aged; D016638:Critical Illness; D005221:Fatigue; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D020380:Needs Assessment; D010166:Palliative Care / Q000706:statistics & numerical data*; D010641:Phenotype; D012866:Skilled Nursing Facilities; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*
keywords: critical care; fatigue; frailty; palliative care