Open AccessMethods of Assessing Frailty in the Critically Ill: A Systematic Review of the Current Literature
Author(s) -
Daniela Bertschi,
Jan Waskowski,
Marianne Schilling,
Claudia Donatsch,
Joerg C. Schefold,
Carmen A. Pfortmueller
Publication year - 2022
Publication title -
gerontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.397
H-Index - 94
eISSN - 1423-0003
pISSN - 0304-324X
DOI - 10.1159/000523674
Subject(s) - medicine , medline , randomized controlled trial , quality of life (healthcare) , systematic review , meta analysis , intensive care , cochrane library , intensive care medicine , intensive care unit , emergency medicine , clinical trial , political science , law , nursing
As new treatments have become established, more frail pre-ICU patients are being admitted to intensive care units (ICUs); this is creating new challenges to provide adequate care and to ensure that resources are allocated in an ethical and economical manner. This systematic review evaluates the current standard for assessing frailty on the ICU, including methods of assessment, time point of measurements, and cut-offs. Methods: A systematic search was conducted on MEDLINE, Clinical Trials, Cochrane Library, and Embase. Randomized and non-randomized controlled studies were included that evaluated diagnostic tools and ICU outcomes for frailty. Exclusion criteria were the following: studies without baseline assessment of frailty on ICU admission, studies in paediatric patients or pregnant women, and studies that targeted very narrow populations of ICU patients. Eligible articles were included until January 31, 2021. Methodological quality was assessed using the Newcastle-Ottawa Scale. No meta-analysis was performed, due to heterogeneity. Results: N = 57 articles (253,376 patients) were included using 19 different methods to assess frailty or a surrogate. Frailty on ICU admission was most frequently detected using the Clinical Frailty Scale (CFS) ( n = 35, 60.3%), the Frailty Index ( n = 5, 8.6%), and Fried’s frailty phenotype ( n = 6, 10.3%). N = 22 (37.9%) studies assessed functional status. Cut-offs, time points, and manner of baseline assessment of frailty on ICU admission varied widely. Frailty on ICU admission was associated with short- and long-term mortality, functional and cognitive impairment, increased health care dependency, and impaired quality of life post-ICU discharge. Conclusions: Frailty assessment on the ICU is heterogeneous with respect to methods, cut-offs, and time points. The CFS may best reflect frailty in the ICU. Frailty assessments should be harmonized and performed routinely in the critically ill.