@article{b2410847f9ad4932beceaf22ef9cb8da,
title = "Frailty, Acute Organ Dysfunction, and Increased Disability After Hospitalization in Older Adults Who Survive Critical Illness: A Prospective Cohort Study",
abstract = "Purpose: We aimed to describe the association between prehospital frailty (PHF), acute organ dysfunction (AOD), and posthospital disability (PHD) outcome in older adults admitted to the intensive care unit (ICU). Methods: In a prospective observational cohort study, we assessed PHF using the Clinical Frailty Scale (CFS) and assessed the level of AOD using Sequential Organ Failure Assessment (SOFA) scores on ICU day 1. We assessed Activities of Daily Living disability levels through to 6 months after discharge and used generalized estimating equations (log link and negative binomial family) to determine the independent association of PHF and AOD with PHD. Results: Of the 302 patients enrolled, 221 (73.1%) survived the hospitalization. Prehospital frailty was associated with PHD (adjusted incident rate ratio [aIRR] 95% confidence interval [95% CI] per unit increase in CFS 1.38 [1.15-1.67], P =.001). Total day 1 SOFA score was weakly associated with PHD, (aIRR [95% CI] 1.05 [1.00-1.10], P =.037) while day 1 SOFA neurologic score was strongly associated with PHD (aIRR [95% CI] 1.42 [1.24-1.62] per unit increase in SOFA neurologic score, P <.001), and these effects were independent of PHF and other premorbid factors. Conclusions: Both PHF and early acute brain dysfunction are important factors associated with increasing PHD in older adults who survive critical illness.",
keywords = "brain dysfunction, disability, frailty, intensive care unit, organ dysfunction, outcomes research",
author = "Hope, {Aluko A.} and Jammie Law and Rahul Nair and Mimi Kim and Joe Verghese and Gong, {Michelle Ng}",
note = "Funding Information: Both PHF and early acute brain dysfunction are important factors associated with increasing PHD in older adults who survive critical illness. organ dysfunction frailty brain dysfunction disability intensive care unit outcomes research National Heart, Lung, and Blood Institute http://dx.doi.org/10.13039/100000050 K01 HL140279 (AAH) edited-state corrected-proof Authors{\textquoteright} Note The study was conceived and designed by AAH, MNG, MK, JV; AAH, JL, RN, MNG performed the data collection. AAH, JL, RN, and MK were involved in the data analysis; AAH and JL prepared the first draft of the manuscript under the guidance of MNG. All authors assisted with data interpretation and preparation of subsequent versions of the manuscript. AAH was the principal investigator of the study and is responsible for the manuscript. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: National Institute of Aging: R03 AG050927 and National Heart, Lung and Blood Institute (NHLBI) K01 HL140279 (AAH), NHLBI U01 HL122998, and UH3 HL125119 (MNG). ORCID iD Aluko A. Hope, MD, MSCE https://orcid.org/0000-0002-7871-7162 Supplemental Material Supplemental material for this article is available online. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: National Institute of Aging: R03 AG050927 and National Heart, Lung and Blood Institute (NHLBI) K01 HL140279 (AAH), NHLBI U01 HL122998, and UH3 HL125119 (MNG). Publisher Copyright: {\textcopyright} The Author(s) 2019.",
year = "2020",
month = dec,
doi = "10.1177/0885066619881115",
language = "English (US)",
volume = "35",
pages = "1505--1512",
journal = "Journal of Intensive Care Medicine",
issn = "0885-0666",
publisher = "SAGE Publications Inc.",
number = "12",
}