CHEST Guidelines-Baseline-Frailty-as-a-Predictor-of-Survival-After-

Baseline-Frailty-as-a-Predictor-of-Survival-After-

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The study explores whether baseline frailty, as assessed through standardized multidimensional health assessments, predicts survival among older adults post-ICU admission. Conducted using community-dwelling older adults (age 65+) in Ontario, Canada, data from April 1, 2009, to March 31, 2015, were analyzed. All individuals had undergone a Resident Assessment Instrument—Home Care (RAI-HC) evaluation within 180 days prior to ICU admission. Frailty was measured using several scales: the Clinical Frailty Scale (CFS), the Frailty Index—Acute Care (FI-AC), and the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS).<br /><br />The study found that among 24,499 individuals admitted to the ICU, 43% survived after a year, and that mortality hazards were higher for those with greater baseline frailty. The models adjusting for frailty exhibited better prediction accuracy than those adjusted for age, sex, clinical category, and income. The findings pointed to the independent association of baseline frailty with post-ICU survival, suggesting its utility in goal-setting and treatment planning in critical care scenarios.<br /><br />The research highlighted challenges in frailty assessment, particularly during the COVID-19 pandemic, recommending emphasis on frailty judgments rather than chronological age. Using data from interRAI health assessments, it demonstrated how frailty could be a valuable metric for resource allocation, particularly in triage decisions. It acknowledged limitations like the exclusion of critically ill patients who died before ICU admission and the potential underestimation of frailty severity since assessments are sometimes outdated due to patient health changes. Ultimately, the study suggests that robust frailty assessments could significantly impact care strategies for critically ill older adults.

Keywords

frailty assessment

ICU survival

older adults

Clinical Frailty Scale

Resident Assessment Instrument

Ontario Canada

mortality prediction

critical care

resource allocation

COVID-19