Frailty assessment in critically ill older adults: a narrative review.

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
L Moïsi, J-C Mino, B Guidet, H Vallet
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引用次数: 0

Abstract

Frailty, a condition that was first defined 20 years ago, is now assessed via multiple different tools. The Frailty Phenotype was initially used to identify a population of "pre-frail" and "frail" older adults, so as to prevent falls, loss of mobility, and hospitalizations. A different definition of frailty, via the Clinical Frailty Scale, is now actively used in critical care situations to evaluate over 65 year-old patients, whether it be for Intensive Care Unit (ICU) admissions, limitation of life-sustaining treatments or prognostication. Confusion remains when mentioning "frailty" in older adults, as to which tools are used, and what the impact or the bias of using these tools might be. In addition, it is essential to clarify which tools are appropriate in medical emergencies. In this review, we clarify various concepts and differences between frailty, functional autonomy and comorbidities; then focus on the current use of frailty scales in critically ill older adults. Finally, we discuss the benefits and risks of using standardized scales to describe patients, and suggest ways to maintain a complex, three-dimensional, patient evaluation, despite time constraints. Frailty in the ICU is common, involving around 40% of patients over 75. The most commonly used scale is the Clinical Frailty Scale (CFS), a rapid substitute for Comprehensive Geriatric Assessment (CGA). Significant associations exist between the CFS-scale and both short and long-term mortality, as well as long-term outcomes, such as loss of functional ability and being discharged home. The CFS became a mainstream tool newly used for triage during the Covid-19 pandemic, in response to the pressure on healthcare systems. It was found to be significantly associated with in-hospital mortality. The improper use of scales may lead to hastened decision-making, especially when there are strains on healthcare resources or time-constraints. Being aware of theses biases is essential to facilitate older adults' access to equitable decision-making regarding critical care. The aim is to help counteract assessments which may be abridged by time and organisational constraints.

Abstract Image

危重症老年人的虚弱评估:叙述性综述。
虚弱是 20 年前首次被定义的一种状况,现在可以通过多种不同的工具进行评估。虚弱表型最初用于识别 "前期虚弱 "和 "后期虚弱 "的老年人群,以预防跌倒、行动不便和住院。目前,临床虚弱量表对虚弱的不同定义已被广泛应用于重症监护领域,对 65 岁以上的患者进行评估,无论是重症监护病房(ICU)的收治、维持生命治疗的限制还是预后评估。在提及老年人的 "虚弱 "时,对于使用哪些工具以及使用这些工具可能产生的影响或偏差,仍然存在困惑。此外,有必要明确哪些工具适用于医疗紧急情况。在这篇综述中,我们将阐明虚弱、功能自主性和合并症之间的各种概念和区别,然后重点介绍目前在重症老年人中使用的虚弱量表。最后,我们讨论了使用标准化量表描述患者的益处和风险,并提出了在时间有限的情况下保持对患者进行复杂、立体评估的方法。重症监护室中的虚弱现象很常见,约有 40% 的 75 岁以上患者会出现这种情况。最常用的量表是临床虚弱量表(CFS),它是老年综合评估(CGA)的快速替代物。临床虚弱量表与短期和长期死亡率以及长期结果(如功能丧失和出院回家)之间存在显著关联。在 Covid-19 大流行期间,为应对医疗系统的压力,CFS 成为了新近用于分流的主流工具。研究发现,该量表与院内死亡率密切相关。量表的不当使用可能会导致决策仓促,尤其是在医疗资源紧张或时间紧迫的情况下。意识到这些偏差对于促进老年人在重症监护方面获得公平决策至关重要。这样做的目的是帮助抵消可能因时间和组织限制而被删减的评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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