Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

Abstract

Frailty represents a condition of vulnerability leading to inadequate recovery following a stressful event, such as an acute illness or injury. This inadequate recovery results from cumulative, multisystem physiological depletion over a lifetime. (1) The frailty state implies that the available functional reserve is insufficient for complete recovery, often leading to a maladaptive response disproportionate to the degree of insult. (2) Frailty syndrome comprises five core components: vulnerability to stressors, multifactorial etiology causing multisystem dysregulation, heterogeneous presentation, clinical measurability, and association with adverse outcomes. (3) These components underscore frailty as a treatable clinical syndrome with a measurable biological basis. (2) Importantly, frailty is separate from but related to older age, multimorbidity or disability. For example, up to 4% of adults less than 65 years of age are frail, and up to 38% are prefrail, with an increasing prevalence in multimorbid patients. (4) Additionally, even though disability and comorbidities overlap with frailty, 8.6% of frail patients have no disabilities or comorbidities. (5) Thus, while conventionally linked to older age and health issues, frailty is now recognized as a dynamic transitional state from robustness to functional decline, potentially preventable or reversible in some cases. (2) The trajectory of critical illness closely aligns with the frailty process. Critical illness affects patients’ functional trajectory, with a substantial proportion of patients facing death or functional decline within a year after intensive care unit (ICU