1
|
Platz T, Schmidt-Wilcke T, Groß M, Friederich C, Pohl M. [Certification by the German Society for Neurorehabiliation, DGNR : Performance and quality of the "Centers for weaning from a ventilator in early neurological and neurosurgical rehabilitation"]. DER NERVENARZT 2024; 95:152-158. [PMID: 37668662 PMCID: PMC10850186 DOI: 10.1007/s00115-023-01540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Certification of centers for weaning from a ventilator in neurological neurosurgical early rehabilitation (NNER) by the German Society for Neurorehabilitation (DGNR) is possible since 1 October 2021. OBJECTIVE The results of certification of facilities in the first year after starting the procedure are presented. MATERIAL AND METHODS As part of the certification process 28 criteria are assessed including a set of mandatory characteristics of the facility. The criteria are divided into structural criteria (i = 7), diagnostic criteria (i = 6), personnel criteria (i = 3), internal organization criteria (i = 7), and quality management criteria (i = 5). RESULTS A total of 13 centers were certified in the first year, with a combined total of 283 beds for weaning from a ventilator in the NNER and served 2278 persons to be weaned from a ventilator in the year before certification, with a median of 134 per facility (range 44-414). Only rarely was weaning unsuccessful, requiring conversion to home mechanical ventilation before discharge (invasive home mechanical ventilation median per facility 10 persons, range 2-25; non-invasive home mechanical ventilation median 0 persons, range 0-57). A high level of process and structural quality was documented for the certified centers: across all areas of assessment, the individual certification criteria were met in the vast majority of cases (median degree of complete fulfilment 86%) or met with improvement potentials documented by the auditors (median 11%). CONCLUSION Successful weaning in NNER and a high level of process and structural quality can be demonstrated by the certification results of centers that follow this integrative approach to weaning from a ventilator in a NNER setting.
Collapse
Affiliation(s)
- Thomas Platz
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Fleischmannstraße 44, 17475, Greifswald, Deutschland.
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland.
| | - Tobias Schmidt-Wilcke
- Neurologisches Zentrum, Bezirksklinikum Mainkofen, Deggendorf, Deutschland
- Institut für Klinische Neurowissenschaften und Medizinische Psychologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Martin Groß
- Evangelisches Krankenhaus Oldenburg, Oldenburg, Deutschland
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | | | - Marcus Pohl
- VAMED Klinik Schloss Pulsnitz, Pulsnitz, Deutschland
| |
Collapse
|
2
|
Valovska T, Joyce M. Resuscitation in older surgical patients. Int Anesthesiol Clin 2023; 61:67-70. [PMID: 37589168 DOI: 10.1097/aia.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Theodora Valovska
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts
| | | |
Collapse
|
3
|
Jain S. Preexisting Care Needs and Long-Term Outcomes After Mechanical Ventilation: Are We Any Closer to Informing Treatment Choices for Older Adults? Crit Care Med 2023; 51:683-685. [PMID: 37052439 DOI: 10.1097/ccm.0000000000005827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| |
Collapse
|
4
|
Jain S, Witt LJ, Ferrante LE. Clin-STAR corner: Recent practice-changing studies at the interface of pulmonary and critical care medicine and geriatrics. J Am Geriatr Soc 2023; 71:705-710. [PMID: 36536494 PMCID: PMC10023292 DOI: 10.1111/jgs.18196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
Older adults suffering from chronic pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung disease, and critical illnesses, such as sepsis and acute respiratory failure, are more vulnerable to adverse outcomes like disability and greater side effects from treatments. In this update, we discuss recent practice-changing clinical trials and observational studies in Pulmonary & Critical Care Medicine that have advanced our understanding of the diagnosis or management of older adults with chronic lung diseases or critical illnesses.
Collapse
Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Leah J. Witt
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, CA
| | - Lauren E. Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| |
Collapse
|
5
|
Brunker LB, Boncyk CS, Rengel KF, Hughes CG. Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges. Clin Interv Aging 2023; 18:93-112. [PMID: 36714685 PMCID: PMC9879046 DOI: 10.2147/cia.s365968] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/12/2023] [Indexed: 01/23/2023] Open
Abstract
There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.
Collapse
Affiliation(s)
- Lucille B Brunker
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina S Boncyk
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly F Rengel
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher G Hughes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
6
|
Elsalam S, Morsy W, Youseif M, Mohammed F. Effect of implementing mobility protocol on selected outcomes among critically ill elderly patients. EGYPTIAN NURSING JOURNAL 2023; 20:104. [DOI: 10.4103/enj.enj_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
7
|
Aliberti MJR, Bailly S, Anstey M. Tailoring treatments to older people in intensive care. A way forward. Intensive Care Med 2022; 48:1775-1777. [PMID: 36357799 PMCID: PMC9649395 DOI: 10.1007/s00134-022-06916-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/13/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSPUniversidade de Sao PauloClinica Medica, Av. Dr. Eneas de Carvalho Aguiar 155, 8º Andar, Sao Paulo, SP, 05403-000, Brazil.
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil.
| | - Sébastien Bailly
- Grenoble Alpes University, Inserm, U1300, Grenoble Alpes University Hospital, Grenoble, France
| | - Matthew Anstey
- Department of Intensive Care, Sir Charles Gairdner Hospital, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- School of Public Health, Curtin University, Perth, Australia
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW The population is aging, and recent epidemiologic work reveals that an increasing number of older adults are presenting to the ICU with preexisting geriatric syndromes. In this update, we discuss recent literature pertaining to the long-term recovery of older ICU patients and highlight gaps in current knowledge. RECENT FINDINGS A recent longitudinal study demonstrated that the incidence of frailty, disability, and multimorbidity among older ICU patients is rising; these geriatric syndromes have all previously been shown to impact long-term recovery. Recent studies have demonstrated the impact of social factors in long-term outcomes after critical illness; for example, social isolation was recently shown to be associated with disability and mortality among older adults in the year after critical illness. Socioeconomic disadvantage is associated with higher rates of dementia and disability following critical illness impacting recovery, and further studies are necessary to better understand factors influencing this disparity. The COVID-19 pandemic disproportionately impacted older adults, resulting in worse outcomes and increased rates of functional decline and social isolation. In considering how to best facilitate recovery for older ICU survivors, transitional care programs may address the unique needs of older adults and help them adapt to new disability if recovery has not been achieved. SUMMARY Recent work demonstrates increasing trends of geriatric syndromes in the ICU, all of which are known to confer increased vulnerability among critically ill older adults and decrease the likelihood of post-ICU recovery. Risk factors are now known to extend beyond geriatric syndromes and include social risk factors and structural inequity. Strategies to improve post-ICU recovery must be viewed with a lens across the continuum of care, with post-ICU recovery programs targeted to the unique needs of older adults.
Collapse
Affiliation(s)
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
9
|
Geen O, Perrella A, Rochwerg B, Wang XM. Applying the geriatric 5Ms in critical care: the ICU-5Ms. Can J Anaesth 2022; 69:1080-1085. [PMID: 35689016 DOI: 10.1007/s12630-022-02270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Olivia Geen
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Andrew Perrella
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
| | - Xuyi Mimi Wang
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
10
|
Rivera-Delgado AI, Ramos-Meléndez EO, Ramírez-Martínez LV, Ruiz-Rodríguez JR, Ruiz-Medina PE, Guerrios-Rivera L, Rodríguez-Ortiz P. Elderly Admission Trends at the Puerto Rico Trauma Hospital: A Time-Series Analysis. J Surg Res 2022; 277:235-243. [DOI: 10.1016/j.jss.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
|
11
|
Cobert J, Jeon SY, Boscardin J, Chapman AC, Ferrante LE, Lee S, Smith AK. Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015. Chest 2022; 161:1555-1565. [PMID: 35026299 PMCID: PMC9248079 DOI: 10.1016/j.chest.2021.12.658] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/23/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Older adults are increasingly admitted to the ICU, and those with disabilities, dementia, frailty, and multimorbidity are vulnerable to adverse outcomes. Little is known about how pre-existing geriatric conditions have changed over time. RESEARCH QUESTION How have changes in disability, dementia, frailty, and multimorbidity in older adults admitted to the ICU changed from 1998 through 2015? STUDY DESIGN AND METHODS Medicare-linked Health and Retirement Survey (HRS) data identifying patients 65 years of age and older admitted to an ICU between 1998 and 2015. ICU admission was the unit of analysis. Year of ICU admission was the exposure. Disability, dementia, frailty, and multimorbidity were identified based on responses to HRS surveys before ICU admission. Disability represented the need for assistance with ≥ 1 activity of daily living. Dementia used cognitive and functional measures. Frailty included deficits in ≥ 2 domains (physical, nutritive, cognitive, or sensory function). Multimorbidity represented ≥ 3 self-reported chronic diseases. Time trends in geriatric conditions were modeled as a function of year of ICU admission and were adjusted for age, sex, race or ethnicity, and proxy interview status. RESULTS Across 6,084 ICU patients, age at admission increased from 77.6 years (95% CI, 76.7-78.4 years) in 1998 to 78.7 years (95% CI, 77.5-79.8 years) in 2015 (P < .001 for trend). The adjusted proportion of ICU admissions with pre-existing disability rose from 15.5% (95% CI, 12.1%-18.8%) in 1998 to 24.0% (95% CI, 18.5%-29.6%) in 2015 (P = .001). Rates of dementia did not change significantly (P = .21). Frailty increased from 36.6% (95% CI, 30.9%-42.3%) in 1998 to 45.0% (95% CI, 39.7%-50.2%) in 2015 (P = .04); multimorbidity rose from 54.4% (95% CI, 49.2%-59.7%) in 1998 to 71.8% (95% CI, 66.3%-77.2%) in 2015 (P < .001). INTERPRETATION Rates of pre-existing disability, frailty, and multimorbidity in older adults admitted to ICUs increased over time. Geriatric principles need to be deeply integrated into the ICU setting.
Collapse
Affiliation(s)
- Julien Cobert
- Anesthesia Service, San Francisco VA Health Care System, San Francisco, CA; Department of Anesthesiology, University of California, San Francisco, CA.
| | - Sun Young Jeon
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Allyson C Chapman
- Division of Critical Care and Palliative Medicine, Department of Internal Medicine, University of California, San Francisco, CA; Department of Surgery, University of California, San Francisco, CA
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Sei Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| |
Collapse
|
12
|
Brummel NE. Increasing Vulnerability in Older Adults With Critical Illness: Implications for Clinical Care and Research. Chest 2022; 161:1436-1437. [PMID: 35680306 PMCID: PMC9168259 DOI: 10.1016/j.chest.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nathan E Brummel
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University College of Medicine, Columbus, OH; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
13
|
Tabootwong W, Jullamate P. Experiences of nursing students in caring for older adults with mechanical ventilation: A descriptive phenomenological study. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Models of Care in Geriatric Intensive Care—A Scoping Review on the Optimal Structure of Care for Critically Ill Older Adults Admitted in an ICU. Crit Care Explor 2022; 4:e0661. [PMID: 35382113 PMCID: PMC8974598 DOI: 10.1097/cce.0000000000000661] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A growing proportion of critically ill patients admitted in ICUs are older adults. The need for improving care provided to older adults in critical care settings to optimize functional status and quality of life for survivors is acknowledged, but the optimal model of care remains unknown. We aimed to identify and describe reported models of care.
Collapse
|
15
|
Geen O, Rochwerg B, Wang XM. Optimisation des soins chez les personnes âgées gravement malades. CMAJ 2021; 193:E1850-1859. [PMID: 34872961 PMCID: PMC8648358 DOI: 10.1503/cmaj.210652-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Olivia Geen
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont.
| | - Bram Rochwerg
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont
| | - Xuyi Mimi Wang
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont
| |
Collapse
|
16
|
Groß M, Pohl M, Platz T, Schmidt-Wilcke T. [The certification of centers for weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation by the German Society for Neurorehabilitation]. DER NERVENARZT 2021; 93:828-834. [PMID: 34648055 PMCID: PMC9363321 DOI: 10.1007/s00115-021-01207-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Die Zertifizierung von Zentren für Beatmungsentwöhnung in der neurologisch-neurochirurgischen Frührehabilitation durch die Deutsche Gesellschaft für Neurorehabilitation (DGNR) ist ab dem 01.10.2021 möglich. Die Zertifizierungskriterien beschreiben ein Anforderungsprofil, das für eine fachgerechte und qualitätsgesicherte Versorgung von Beatmungspatienten in der neurologisch-neurochirurgischen Frührehabilitation (NNFR) steht. Das Zertifikat berücksichtigt die strukturellen Unterschiede der in der NNFR tätigen Einrichtungen und kann sowohl durch Facheinrichtungen als auch durch Frührehabilitationsabteilungen an Akutkrankenhäusern erworben werden. Die Durchführung der Zertifizierung erfolgt analog zur Zertifizierung von Stroke-Units der Deutschen Schlaganfall-Gesellschaft in Zusammenarbeit mit dem TÜV Rheinland. Zunächst sendet die Einrichtung den Erhebungsbogen an den TÜV Rheinland. Anschließend erfolgt die Begehung durch einen vom TÜV Rheinland gestellten leitenden Auditor und einen Fachauditor der DGNR. Deren Bericht wird dem Zertifizierungsausschuss der DGNR vorgelegt zur Erteilung einer Empfehlung oder Ablehnung der Zertifizierung. Die Zertifizierung schafft objektive Kriterien, die die Rolle der Neurologie in der Beatmungsmedizin in Deutschland beschreiben. So erleichtert sie den Dialog mit anderen beatmungsmedizinischen Disziplinen und ebnet den Weg für die Diskussion mit Politikern, Kostenträgern und nicht zuletzt Betroffenenverbänden über Behandlungsinhalte und -kapazitäten.
Collapse
Affiliation(s)
- Martin Groß
- Zertifizierungsausschuss der Deutschen Gesellschaft für Neurorehabilitation e. V., Rheinbach, Deutschland.,Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.,Evangelisches Krankenhaus Oldenburg, Oldenburg, Deutschland
| | - Marcus Pohl
- Zertifizierungsausschuss der Deutschen Gesellschaft für Neurorehabilitation e. V., Rheinbach, Deutschland.,VAMED Klinik Schloss Pulsnitz, Pulsnitz, Deutschland
| | - Thomas Platz
- Präsidium der Deutschen Gesellschaft für Neurorehabilitation e. V., Rheinbach, Deutschland. .,Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald gGmbH, Zentrum für NeuroRehabilitation Beatmungs- und Intensivmedizin Querschnittgelähmtenzentrum, Karl-Liebknecht-Ring 26a, 17491, Greifswald, Deutschland. .,Arbeitsgruppe Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland.
| | - Tobias Schmidt-Wilcke
- Zertifizierungsausschuss der Deutschen Gesellschaft für Neurorehabilitation e. V., Rheinbach, Deutschland.,Neurologisches Zentrum, Mainkofen, Deutschland.,Institut für Klinische Neurowissenschaften und Medizinische Psychologie, Heinrich-Heine - Universität Düsseldorf, Düsseldorf, Deutschland
| |
Collapse
|
17
|
Affiliation(s)
- Olivia Geen
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont.
| | - Bram Rochwerg
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont
| | - Xuyi Mimi Wang
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont
| |
Collapse
|
18
|
Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 2. Crit Care Clin 2021; 37:221-231. [PMID: 33190772 DOI: 10.1016/j.ccc.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As life expectancy increases and birth rates decline, the geriatric population continues to grow faster than any other age group. Aging is characterized by a progressive physiologic decline that promotes the onset of functional limitation and disability. With the increasing geriatric population, more elderly patients are presenting to emergency departments after trauma, and intensive care units are being met with increasing demand. Rehabilitation is critical in improving quality of life by maximizing physical, cognitive, and psychological recovery from injury or disease.
Collapse
|
19
|
Abstract
Identification of the appropriate pressure injury (PI) risk factors is the first step in successful PI prevention. Measuring PI risk through formalized PI risk assessment is an essential component of any PI prevention program. Major PI risk factors identified in the empirical literature in the critical care population include age, diabetes, hypotension, mobility, prolonged intensive care unit admission, mechanical ventilation and vasopressor administration. Future risk assessment using sophisticated data analytics available in the electronic medical record may result in earlier, targeted PI prevention and will improve our understanding of risk factors that may contribute to unavoidable PIs.
Collapse
|
20
|
Darvall JN, Bellomo R, Paul E, Bailey M, Young PJ, Reid A, Rockwood K, Pilcher D. Routine Frailty Screening in Critical Illness: A Population-Based Cohort Study in Australia and New Zealand. Chest 2021; 160:1292-1303. [PMID: 34089741 DOI: 10.1016/j.chest.2021.05.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Frailty is associated with poor outcomes in critical illness. However, it is unclear whether frailty screening on admission to the ICU can be conducted routinely at the population level and whether it has prognostic importance. RESEARCH QUESTION Can population-scale frailty screening with the Clinical Frailty Scale (CFS) be implemented for critically ill adults in Australia and New Zealand (ANZ) and can it identify patients at risk of negative outcomes? STUDY DESIGN AND METHODS We conducted a binational prospective cohort study of critically ill adult patients admitted between July 1, 2018, and June 30, 2020, in 175 ICUs in ANZ. We classified frailty with the CFS on admission to the ICU. The primary outcome was in-hospital mortality; secondary outcomes were length of stay (LOS), discharge destination, complications (delirium, pressure injury), and duration of survival. RESULTS We included 234,568 critically ill patients; 45,245 (19%) were diagnosed as living with frailty before ICU admission. Patients with vs without frailty had higher in-hospital mortality (16% vs 5%; P < .001), delirium (10% vs 4%; P < .001), longer LOS in the ICU and hospital, and increased new chronic care discharge (3% vs 1%; P < .001), with worse outcomes associated with increasing CFS category. Of patients with very severe frailty (CFS score, 8), 39% died in hospital vs 2% of very fit patients (CFS score, 1; multivariate categorical CFS score, 8 [reference, 1]; OR, 7.83 [95% CI, 6.39-9.59]; P < .001). After adjustment for illness severity, frailty remained highly significantly predictive of mortality, including among patients younger than 50 years, with improvement in the area under the receiver operating characteristic curve of the Acute Physiology and Chronic Health Evaluation III-j score to 0.882 (95% CI, 0.879-0.885) from 0.868 (95% CI, 0.866-0.871) with the addition of frailty (P < .001). INTERPRETATION Large-scale population screening for frailty degree in critical illness was possible and prognostically important, with greater frailty (especially CFS score of ≥ 6) associated with worse outcomes, including among younger patients.
Collapse
Affiliation(s)
- Jai N Darvall
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
| | - Rinaldo Bellomo
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Data Analytics Research & Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, VIC, Australia
| | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Bailey
- Department of Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alice Reid
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Kenneth Rockwood
- Divisions of Geriatric Medicine & Neurology, and the Geriatric Medicine Research Unit, Division of Geriatric Medicine, Department of Medicine, Dalhousie University and Nova Scotia Health Authority, NS, Canada
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| |
Collapse
|
21
|
Isshiki Y, Nakajima J, Sawada Y, Ichikawa Y, Fukushima K, Aramaki Y, Oshima K. Efficacy of the treatment for elderly emergency patients with sepsis. Heliyon 2021; 7:e07150. [PMID: 34136701 PMCID: PMC8180618 DOI: 10.1016/j.heliyon.2021.e07150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives We evaluated the impact of age in septic patients admitted through the ER on clinical outcome and cost. Methods Patients with sepsis admitted to the intensive care unit (ICU) through the emergency room in our hospital between January 2013 and December 2018 were analyzed. They were divided into three groups according to their age: <65 years (group Y); 65–79 years (group M); and ≥80 years (group E). The duration of ICU and hospital stay, prognosis, and total hospital costs were compared among the three groups. Results During this period, 1,392 patients were admitted to the ICU through the emergency room, and 174 patients with sepsis were analyzed. There were 49, 79, and 46 patients in groups Y, M, and E, respectively. There was no significant difference in ICU stay. Group E exhibited the shortest hospital stay and the lowest total hospital cost with statistically significant difference (p = 0.010 and p = 0.007, respectively). However, group E showed the highest rate of hospital mortality (30.4%) compared to groups Y and M (14.3% and 21.5%, respectively; p = 0.163). Conclusions Elderly (aged ≥80 years) emergency patients with sepsis require shorter hospital stay and are associated with lower total hospital cost. However, it may be difficult for these patients to maintain the hospital mortality equivalent to those observed in patients aged <80 years.
Collapse
Affiliation(s)
- Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Jun Nakajima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yuto Aramaki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| |
Collapse
|
22
|
Bae G, Lim F. The Impact of Nonpharmacological Interventions on Sleep Quality Among Older Adult Patients in the Intensive Care Unit. Crit Care Nurs Q 2021; 44:214-229. [PMID: 33595968 DOI: 10.1097/cnq.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sleep is a basic human need that is required for good health and overall well-being. Adequate sleep is critical for cognitive functioning, memory consolidation, and emotional regulation by rejuvenating the body. Sleep may not be of significant concern unless it becomes lacking or disturbed as it alters the immune function, neurological processes, and intellectual and decision making of individuals. Hospitalized older adults are particularly vulnerable for the negative impact of poor sleep due to reduced physiological reserve and comorbidities. The purpose of this review is to appraise current evidence on nonpharmacological sleep interventions to promote better sleep quality and overall health outcomes among the general adult and older patients in the intensive care unit compared with no intervention at all. The findings of this integrative review will be useful in designing and implementing interdisciplinary plans of care that promote the use of nonpharmacological sleep protocols within the hospital setting.
Collapse
Affiliation(s)
- Grace Bae
- Keck Medical Center of USC, Los Angeles, California (Ms Bae) and New York University Meyers College of Nursing (Dr Lim)
| | | |
Collapse
|
23
|
Kao CC, Chen YC, Huang HH, Hsu TF, Yen DHT, Fan JS. Prognostic significance of emergency department modified early warning score trend in critical ill elderly patients. Am J Emerg Med 2021; 44:14-19. [PMID: 33571750 DOI: 10.1016/j.ajem.2021.01.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To explore the relationship between trends in emergency department modified early warning score (EDMEWS) and the prognosis of elderly patients admitted to the intensive care unit (ICU). METHODS Consecutive non-traumatic elderly ED patients (≥65 years old) admitted to the ICU between July 2018 and June 2019 were enrolled in this retrospective cohort study. The selected patients had at least 2 separate MEWS during their ED stay. Detailed patient information was retrieved initially from the ICU database of our hospital and then crosschecked with electronic medical recording system to confirm the completeness and correctness of the data. Patients who had do-not-resuscitate order and those with incomplete data of EDMEWS, acute physiology and chronic health evaluation (APACHE) II score, or survival information (7-day and 30-day mortality) were excluded. The trends in EDMEWS were determined using the regression line of multiple MEWS measured during ED stay, in which EDMEWS trend progression was defined as the slope of the regression line > zero. The relationship between EDMEWS trend and prognosis was assessed using univariate and multivariate analyses (multiple logistic regression analysis). RESULTS Of the 1423 selected patients, 499 (35.1%) had worsening 24-h APACHE II score, 110 (7.7%) died within 7 days, and 233 (16.4%) died within 30 days. Factors that were significantly associated with worsening 24-h APACHE II score, 7-day mortality, and 30-day mortality in univariate analysis were selected for inclusion into multiple logistic regression analyses. After adjusting for other covariates, EDMEWS trend progression was significantly associated with 24-h APACHE II score progression, 7-day mortality, and 30-day mortality. CONCLUSIONS EDMEWS trend progression was significantly associated with 24-h APACHE II score progression, 7-day mortality, and 30-day mortality in elderly ED patients admitted to the ICU. EDMEWS is a simple and useful tool for precisely monitoring patients' ongoing condition and predicting prognosis.
Collapse
Affiliation(s)
- Chih-Chun Kao
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yen-Chia Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - The-Fu Hsu
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - David Hung-Tsang Yen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ju-Sing Fan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| |
Collapse
|
24
|
Stubbs BJ, Koutnik AP, Goldberg EL, Upadhyay V, Turnbaugh PJ, Verdin E, Newman JC. Investigating Ketone Bodies as Immunometabolic Countermeasures against Respiratory Viral Infections. MED 2020; 1:43-65. [PMID: 32838361 PMCID: PMC7362813 DOI: 10.1016/j.medj.2020.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Respiratory viral infections remain a scourge, with seasonal influenza infecting millions and killing many thousands annually and viral pandemics, such as COVID-19, recurring every decade. Age, cardiovascular disease, and diabetes mellitus are risk factors for severe disease and death from viral infection. Immunometabolic therapies for these populations hold promise to reduce the risks of death and disability. Such interventions have pleiotropic effects that might not only target the virus itself but also enhance supportive care to reduce cardiopulmonary complications, improve cognitive resilience, and facilitate functional recovery. Ketone bodies are endogenous metabolites that maintain cellular energy but also feature drug-like signaling activities that affect immune activity, metabolism, and epigenetics. Here, we provide an overview of ketone body biology relevant to respiratory viral infection, focusing on influenza A and severe acute respiratory syndrome (SARS)-CoV-2, and discuss the opportunities, risks, and research gaps in the study of exogenous ketone bodies as novel immunometabolic interventions in these diseases.
Collapse
Affiliation(s)
| | - Andrew P Koutnik
- Institute for Human and Machine Cognition, Pensacola, FL, USA
- Department of Molecular Pharmacology and Physiology, USF, Tampa, FL, USA
| | | | - Vaibhav Upadhyay
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, UCSF, San Francisco, CA, USA
- Department of Microbiology and Immunology, UCSF, San Francisco, CA, USA
| | - Peter J Turnbaugh
- Department of Microbiology and Immunology, UCSF, San Francisco, CA, USA
| | - Eric Verdin
- Buck Institute for Research on Aging, Novato, CA, USA
| | - John C Newman
- Buck Institute for Research on Aging, Novato, CA, USA
- Division of Geriatrics, UCSF, San Francisco, CA, USA
| |
Collapse
|
25
|
The Association between Prehospital Vulnerability, ARDS Development, and Mortality among At-Risk Adults. Results from the LIPS-A Clinical Trial. Ann Am Thorac Soc 2020; 16:1399-1404. [PMID: 31453722 DOI: 10.1513/annalsats.201902-116oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rationale: No previous studies have examined the role of prehospital vulnerability in acute respiratory distress syndrome (ARDS) development and mortality in an acutely ill adult population.Objectives: To describe the association between prehospital vulnerability and 1) the development of ARDS, 2) 28-day mortality, and 3) 1-year mortality.Methods: This was a longitudinal prospective cohort study nested within the multicenter LIPS-A (Lung Injury Prevention Study-Aspirin) trial. We analyzed 301 participants who completed Vulnerable Elders Survey (VES) at baseline. Multivariable logistic regression and Cox regression analyses were used to describe the association between vulnerability and short-term outcomes (ARDS and 28-day mortality) and long-term outcomes (1-year mortality), respectively.Results: The VES score ranged from 0 to 10 (median [interquartile range], 2.0 [0-6]); 143 (47.5%) fit criteria for prehospital vulnerability (VES ≥ 3). Vulnerability was not significantly associated with ARDS development (10 [7.0%] vulnerable patients developed ARDS as per LIPS-A study criteria vs. 20 [12.7%] without vulnerability; P = 0.10; adjusted odds ratio [95% confidence interval (CI)], 0.54 [0.24-1.24]; P = 0.15). Nor was vulnerability associated with 28-day mortality (15 [10.5%] vulnerable patients were dead by Day 28 vs. 11 [7.0%] nonvulnerable patients; P = 0.28; adjusted odds ratio [95% CI], 0.95 [0.39-2.26]; P = 0.90). Vulnerability was significantly associated with 1-year mortality in hospital survivors (35 [26.9%] vs. 13 [9.3%]; adjusted hazard ratio [95% CI], 2.20 [1.10-4.37]; P = 0.02).Conclusions: In a population of adults recruited for their high risk of ARDS, prehospital vulnerability, measured by VES, was highly prevalent and strongly associated with 1-year mortality.
Collapse
|
26
|
Jones JRA, Griffith DM. The 6 Ps of post-ICU recovery: application of a shared conceptual model. Curr Opin Clin Nutr Metab Care 2020; 23:367-372. [PMID: 32740161 DOI: 10.1097/mco.0000000000000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We aimed to explore, through a conceptual model, how we can maximize the post-ICU recovery of patients with ICU-acquired weakness (ICU-AW). The '6 Ps' were used to structure our research questions, what are the Predisposing (pre-ICU patient characteristics), Precipitating (ICU exposures) and Perpetuating (hinder recovery) risk factors for ICU-AW (Problem) and what Protective strategies and Proactive treatment can we adopt to improve muscle mass, strength and function of these patients? RECENT FINDINGS Examination of the relationship between pre-ICU patient characteristics with ICU-AW and post-ICU factors that prolong recovery are limited. Our understanding of the pathophysiology of the condition is improving, however, much of the biological mechanisms of ICU-AW and persistent weakness remain unknown. Investigation into the ICU-AW phenotype and prediction tools would be of great clinical utility. Further research on ICU-AW muscle biology and recovery may permit the application of precision and personalized medicine to therapeutic interventions. SUMMARY A structured approach to clinical practice and future research to better understand the mechanism (Problem), and identify Predisposing, Precipitating and Perpetuating risk factors will advance the field in better managing ICU-AW through implementation of Protective strategies and Proactive multimodal treatments.
Collapse
Affiliation(s)
- Jennifer R A Jones
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria Australia
| | - David M Griffith
- Anaesthesia, Critical Care and Pain, Division of Health Sciences, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
27
|
Damluji AA, Forman DE, van Diepen S, Alexander KP, Page RL, Hummel SL, Menon V, Katz JN, Albert NM, Afilalo J, Cohen MG. Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e6-e32. [DOI: 10.1161/cir.0000000000000741] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.
Collapse
|
28
|
Hope AA, Munoz M, Hsieh SJ, Gong MN. Surrogates' and Researchers' Assessments of Prehospital Frailty in Critically Ill Older Adults. Am J Crit Care 2019; 28:117-123. [PMID: 30824515 DOI: 10.4037/ajcc2019285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prehospital frailty has been associated with adverse hospital outcomes in critically ill adults. Although frailty assessment in intensive care units depends on patients' surrogates, frailty assessments by surrogates and researchers have not been compared. OBJECTIVES To compare agreement and validity between surrogates' and researchers' assessments of frailty in critically ill older adults. METHODS An observational cohort study of adults (aged ≥ 50 years) admitted to a medical/surgical intensive care unit was conducted. On admission, patients' surrogates quantified prehospital frailty by using the Clinical Frailty Scale (range, 1-9; scores > 4 defined as frail). Researchers blinded to surrogates' assessments also quantified frailty. Agreement was described with κ scores, McNemar tests, and Bland-Altman plots; validity was compared by using χ2 tests and logistic regression. RESULTS For 298 patients (mean [SD] age, 67.2 [10.5] years), both surrogates' and researchers' frailty assessment scores ranged from 1 to 9, with moderate to substantial agreement between scores (g ≥ 0.40). Surrogates' frailty assessment scores were significantly lower than researchers' (mean difference, -0.62; 95% CI, -0.77 to -0.48; P < .001). Surrogates were less likely than researchers to identify as frail those patients who experienced adverse hospital outcomes (death, prolonged stay, or disability newly identified at discharge). CONCLUSIONS Surrogates identified fewer patients as frail than did researchers. Factors involved in surrogates' assessments of patients' prehospital frailty status should be studied to see if the Clinical Frailty Scale can be modified to facilitate more accurate surrogate assessments.
Collapse
Affiliation(s)
- Aluko A. Hope
- Aluko A. Hope is an associate professor, Missiel Munoz is a research coordinator, and Michelle Ng Gong is a professor in the Department of Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York. S. J. Hsieh is an associate professor in the Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Missiel Munoz
- Aluko A. Hope is an associate professor, Missiel Munoz is a research coordinator, and Michelle Ng Gong is a professor in the Department of Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York. S. J. Hsieh is an associate professor in the Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - S. J. Hsieh
- Aluko A. Hope is an associate professor, Missiel Munoz is a research coordinator, and Michelle Ng Gong is a professor in the Department of Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York. S. J. Hsieh is an associate professor in the Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle Ng Gong
- Aluko A. Hope is an associate professor, Missiel Munoz is a research coordinator, and Michelle Ng Gong is a professor in the Department of Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York. S. J. Hsieh is an associate professor in the Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|