Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Feasibility and reliability of frailty assessment in the critically ill: a systematic review

Authors: Richard J. Pugh, Amy Ellison, Kate Pye, Christian P. Subbe, Chris M. Thorpe, Nazir I. Lone, Andrew Clegg

Published in: Critical Care | Issue 1/2018

Login to get access

Abstract

Background

For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care.

Methods

Our primary search was conducted in Medline, Medline In-process, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Database of Systematic Reviews, and Web of Science (January 2001 to October 2017). We included observational studies reporting data on feasibility and reliability of frailty assessment in the critical care setting in patients 16 years and older. Feasibility was assessed in terms of timing of evaluation, the background, training and expertise required for assessors, and reliance upon proxy input. Reliability was assessed in terms of inter-rater reliability.

Results

Data from 11 study publications are included, representing 8 study cohorts and 7761 patients. Proxy involvement in frailty assessment ranged from 58 to 100%. Feasibility data were not well-reported overall, but the exclusion rate due to lack of proxy availability ranged from 0 to 45%, the highest rate observed where family involvement was mandatory and the assessment tool relatively complex (frailty index, FI). Conventional elements of frailty phenotype (FP) assessment required modification prior to use in two studies. Clinical staff tended to use a simple judgement-based tool, the clinical frailty scale (CFS). Inter-rater reliability was reported in one study using the CFS and although a good level of agreement was observed between clinician assessments, this was a small and single-centre study.

Conclusion

Though of unproven reliability in the critically ill, CFS was the tool used most widely by critical care clinical staff. Conventional FP assessment required modification for general application in critical care, and an FI-based assessment may be difficult to deliver by the critical care team on a routine basis. There is a high reliance on proxies for frailty assessment, and the reliability of frailty assessment tools in critical care needs further evaluation.

Prospero registration number

Literature
1.
Bagshaw SM, Webb SA, Delaney A, George C, Pilcher D, Hart GK, Bellomo R. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care. 2009;13(2):R45.CrossRefPubMedPubMedCentral
2.
Ihra GC, Lehberger J, Hochrieser H, Bauer P, Schmutz R, Metnitz B, Metnitz PG. Development of demographics and outcome of very old critically ill patients admitted to intensive care units. Intensive Care Med. 2012;38(4):620–6.CrossRefPubMed
3.
Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, Sibley S, Rockwood K. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105–22.CrossRefPubMedPubMedCentral
4.
5.
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.CrossRefPubMed
6.
de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG. Nijhuis-van der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.CrossRefPubMed
7.
Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3–10.CrossRefPubMed
8.
Sutton JL, Gould RL, Daley S, Coulson MC, Ward EV, Butler AM, Nunn SP, Howard RJ. Psychometric properties of multicomponent tools designed to assess frailty in older adults: a systematic review. BMC Geriatr. 2016;16:55.CrossRefPubMedPubMedCentral
9.
Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, Bandeen-Roche K, Varadhan R. Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev. 2016;26:53–61.CrossRefPubMed
10.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.CrossRefPubMedPubMedCentral
11.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.CrossRefPubMed
12.
Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010;11(5):344–55.CrossRefPubMed
13.
Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc. 2004;52(11):1929–33.CrossRefPubMed
14.
Hogan DB, Maxwell CJ, Afilalo J, Arora RC, Bagshaw SM, Basran J, Bergman H, Bronskill SE, Carter CA, Dixon E, et al. A scoping review of frailty and acute care in middle-aged and older individuals with recommendations for future research. Can Geriatr J. 2017;20(1):22–37.CrossRefPubMedPubMedCentral
15.
Apostolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, Holland C. Predicting risk and outcomes for frail older adults: an umbrella review of frailty screening tools. JBI Database System Rev Implement Rep. 2017;15(4):1154–208.CrossRefPubMedPubMedCentral
16.
Neumann PJ, Araki SS, Gutterman EM. The use of proxy respondents in studies of older adults: lessons, challenges, and opportunities. J Am Geriatr Soc. 2000;48(12):1646–54.CrossRefPubMed
17.
Li M, Harris I, Lu ZK. Differences in proxy-reported and patient-reported outcomes: assessing health and functional status among medicare beneficiaries. BMC Med Res Methodol. 2015;15:62.CrossRefPubMedPubMedCentral
18.
Scales DC, Tansey CM, Matte A, Herridge MS. Difference in reported pre-morbid health-related quality of life between ARDS survivors and their substitute decision makers. Intensive Care Med. 2006;32(11):1826–31.CrossRefPubMed
19.
Dinglas VD, Gifford JM, Husain N, Colantuoni E, Needham DM. Quality of life before intensive care using EQ-5D: patient versus proxy responses. Crit Care Med. 2013;41(1):9–14.CrossRefPubMedPubMedCentral
20.
Hilmer SN, Perera V, Mitchell S, Murnion BP, Dent J, Bajorek B, Matthews S, Rolfson DB. The assessment of frailty in older people in acute care. Australas J Ageing. 2009;28(4):182–8.CrossRefPubMed
21.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.CrossRefPubMed
22.
Turner G, Clegg A: Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report; 2014.
23.
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539–49.CrossRefPubMedPubMedCentral
24.
25.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral
26.
Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. Can Med Assoc J. 2014;186(2):E95–E102.CrossRef
27.
Bagshaw SM, Stelfox HT, Johnson JA, McDermid RC, Rolfson DB, Tsuyuki RT, Ibrahim Q, Majumdar SR. Long-Term Association Between Frailty and Health-Related Quality of Life Among Survivors of Critical Illness: a prospective multicenter cohort study. Crit Care Med. 2015;43(5):973–82.CrossRefPubMed
28.
Bagshaw M, Majumdar SR, Rolfson DB, Ibrahim Q, McDermid RC, Stelfox HT. A prospective multicenter cohort study of frailty in younger critically ill patients. Crit Care. 2016;20(1):175. Erratum in: Crit Care. 2016;20(1):223.CrossRefPubMedPubMedCentral
29.
Brummel NE, Bell SP, Girard TD, Pandharipande PP, Jackson JC, Morandi A, Thompson JL, Chandrasekhar R, Bernard GR, Dittus RS, et al. Frailty and subsequent disability and mortality among patients with critical illness. Am J Respir Crit Care Med. 2017;196(1):64–72.CrossRefPubMed
30.
Le Maguet P, Roquilly A, Lasocki S, Asehnoune K, Carise E, Saint Martin M, Mimoz O, Le Gac G, Somme D, Cattenoz C, et al. Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med. 2014;40(5):674–82.PubMed
31.
32.
Fisher C, Karalapillai DK, Bailey M, Glassford NG, Bellomo R, Jones D. Predicting intensive care and hospital outcome with the Dalhousie Clinical Frailty Scale: a pilot assessment. Anaesth Intensive Care. 2015;43(3):361–8.PubMed
33.
Heyland DK, Garland A, Bagshaw SM, Cook D, Rockwood K, Stelfox HT, Dodek P, Fowler RA, Turgeon AF, Burns K, et al. Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study. Intensive Care Med. 2015;41(11):1911–20.CrossRefPubMed
34.
Heyland D, Cook D, Bagshaw SM, Garland A, Stelfox HT, Mehta S, Dodek P, Kutsogiannis J, Burns K, Muscedere J, et al. The very elderly admitted to ICU: a quality finish? Crit Care Med. 2015;43(7):1352–60.CrossRefPubMed
35.
Hope AA, Hsieh SJ, Petti A, Hurtado-Sbordoni M, Verghese J, Gong MN. Assessing the usefulness and validity of frailty markers in critically ill adults. Ann Am Thorac Soc. 2017;14(6):952–9.
36.
Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, Boumendil A, Cecconi M, Christensen S, Faraldi L, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (>/= 80 years). Intensive Care Med. 2017;43(12):1820–1828.CrossRefPubMed
37.
Baldwin MR, Reid MC, Westlake AA, Rowe JW, Granieri EC, Wunsch H, Dam TT, Rabinowitz D, Goldstein NE, Maurer MS, et al. The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors. J Crit Care. 2014;29(3):401–8.CrossRefPubMedPubMedCentral
38.
Theou O, Cann L, Blodgett J, Wallace LM, Brothers TD, Rockwood K. Modifications to the frailty phenotype criteria: Systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, Ageing, and Retirement in Europe. Ageing Res Rev. 2015;21:78–94.CrossRefPubMed
39.
Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E, Mohammed MA, Parry J, Marshall T. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016;45(3):353–60.CrossRefPubMedPubMedCentral
40.
Ahasic AM, Van Ness PH, Murphy TE, Araujo KL, Pisani MA. Functional status after critical illness: agreement between patient and proxy assessments. Age Ageing. 2015;44(3):506–10.CrossRefPubMed
41.
Iwashyna TJ. Trajectories of recovery and dysfunction after acute illness, with implications for clinical trial design. Am J Respir Crit Care Med. 2012;186(4):302–4.CrossRefPubMedPubMedCentral
42.
Carod-Artal FJ, Ferreira Coral L, Stieven Trizotto D, Menezes MC. Self- and proxy-report agreement on the Stroke Impact Scale. Stroke. 2009;40(10):3308–14.CrossRefPubMed
43.
Oczkowski C, O'Donnell M. Reliability of proxy respondents for patients with stroke: a systematic review. J Stroke Cerebrovasc Dis. 2010;19(5):410–6.CrossRefPubMed
44.
Rodriguez-Molinero A, Lopez-Dieguez M, Tabuenca AI, de la Cruz JJ, Banegas JR. Physicians' impression on the elders' functionality influences decision making for emergency care. Am J Emerg Med. 2010;28(7):757–65.CrossRefPubMed
Metadata
Title
Feasibility and reliability of frailty assessment in the critically ill: a systematic review
Authors
Richard J. Pugh
Amy Ellison
Kate Pye
Christian P. Subbe
Chris M. Thorpe
Nazir I. Lone
Andrew Clegg
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-1953-9

Other articles of this Issue 1/2018

Critical Care 1/2018 Go to the issue

Letter

“Think. Check. Submit.” to avoid predatory publishing

Research

Neuromuscular blockade is associated with the attenuation of biomarkers of epithelial and endothelial injury in patients with moderate-to-severe acute respiratory distress syndrome

Research

Inclusion and definition of acute renal dysfunction in critically ill patients in randomized controlled trials: a systematic review

Letter

The choice of a postpyloric tube and the patient’s position in our procedure: A response

Research

Evaluation of a real-time PCR assay for detection and quantification of bacterial DNA directly in blood of preterm neonates with suspected late-onset sepsis

Research

Can probiotics be an alternative to chlorhexidine for oral care in the mechanically ventilated patient? A multicentre, prospective, randomised controlled open trial