Frailty in the prediction of delirium in the intensive care unit: A secondary analysis of the <i>Deli study</i>

Frost, Steven A.; Brennan, Kathleen; Sanchez, David; Lynch, Joan; Hedges, Sonja; Hou, Yu Chin; El Sayfe, Masar; Shunker, Sharon‐Ann; Bogdanovski, Tony; Hunt, Leanne; Alexandrou, Evan; Rolls, Kaye; Chroinin, Danielle Ni; Aneman, Anders

doi:10.1111/aas.14343

Cited by 3 publications

(1 citation statement)

References 74 publications

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“…The relationship between delirium and frailty seems also to be independent of the tools used for detecting frailty [ 13 ]. For this reason, the inclusion of frailty assessment ameliorated the performance of delirium clinical prediction tools in the Intensive Care Unit (ICU) setting [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome

Ticinesi,

Parise,

Delmonte

et al. 2024

Eur Geriatr Med

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Purpose Delirium risk assessment in the acute-care setting generally does not account for frailty. The objective of this retrospective study was to identify factors associated with delirium, considering the interdependency of clinical variables with frailty syndrome in complex older patients. Methods The clinical records of 587 participants (248 M, median age 84) were reviewed, collecting clinical, anamnestic and pharmacological data. Frailty syndrome was assessed with the Clinical Frailty Scale (CFS). Delirium was the main study endpoint. The correlations of the considered anamnestic and clinical variables with delirium and its subtypes were investigated selecting only those variables not showing a high overlap with frailty. Correlations associated with a 25% excess of frequency of delirium in comparison with the average of the population were considered as statistically significant. Results Delirium was detected in 117 (20%) participants. The presence of one among age > 85 years old, CFS > 4 and invasive devices explained 95% of delirium cases. The main factors maximizing delirium incidence at the individual level were dementia, other psychiatric illness, chronic antipsychotic treatment, and invasive devices. The coexistence of three of these parameters was associated with a peak frequency of delirium, ranging from 57 to 61%, mostly hypoactive forms. Conclusions In acute-care wards, frailty exhibited a strong association with delirium during hospitalization, while at the individual level, dementia and the use of antipsychotics remained important risk factors. Modern clinical prediction tools for delirium should account for frailty syndrome.

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Section: Discussionmentioning

confidence: 99%

Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome

Ticinesi,

Parise,

Delmonte

et al. 2024

Eur Geriatr Med

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Frailty in the cardiac intensive care unit: assessment and impact

Moumneh,

Jamil,

Kalra

et al. 2024

European Heart Journal: Acute Cardiovascular Care

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Frailty, a clinical syndrome of increased vulnerability, due to diminished cognitive, physical, and physiological reserves is a growing concern in the cardiac intensive care unit (CICU). It contributes to morbidity, mortality, and complications and often exerts a bidirectional association with cardiovascular disease. Althought it predominately affects older adults, frailty can also be observed in younger patients less than 65 years of age, with approximately 30% of those admitted CICU are frail. Acute cardiovascular illness can also impair physical and cognitive functioning among survivors and these survivors often suffer from frailty and functional declines post-CICU discharge. Patients with frailty in the CICU often have higher comorbidity burden and they are less likely to receive optimal therapy for their acute cardiovascular conditions. Given the significance of this geriatric syndrome, this review will focus on assessment, clinical outcomes, and interventions, in an attempt to establish appropriate assessment, management, and resource utilization in frail patients during and after CICU admission.

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Implications of frailty before and after intensive care unit admission

Gordon,

Brummel

2024

Current Opinion in Critical Care

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Purpose of review In the decade since the first publications related to frailty in those with critical illness, the study of frailty has rapidly increased. The purpose of this review is to update the reader on recent advances across several important areas of frailty research: how best to identify frailty in those with critical illness, studies describing the relationship between frailty and delirium, and how frailty affects outcomes for those with coronavirus disease 2019 (COVID-19), which, despite rates and severity of acute infection declining, still tremendously impacts patients long after the acute infection, resulting in symptoms of long COVID-19. Recent findings A number of frailty assessment tools exist, to date, the Clinical Frailty Scale based on the deficit accumulation approach to defining frailty, is the most commonly used in ICU studies. Several novel frailty instruments for the ICU are being developed. Because tools assessing frailty by the phenotypic and deficit accumulation approaches identify different populations, careful choice of a frailty assessment tool is warranted. Frailty and delirium are hypothesized to represent different clinical expressions of a similar underlying vulnerability, thus identifying frailty may be a useful means by which to identify patients at high risk of becoming delirious. Recent studies show that frailty at ICU admission is a predictor of the development of delirium. Finally, frailty and its outcomes were studied in patients with COVID-19. As with other causes of critical illness, frailty was highly prevalent in those admitted to the ICU and is associated with greater mortality. Frailty was also associated with increased decisions to limit life support treatments, but these decisions were not different among those admitted with COVID-19 or for other reasons. Summary Frailty in those with critical illness is an emerging field of study. Future work to define the optimal means by which to identify this syndrome and how best to manage critically ill patients with frailty are needed.

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Frailty in the prediction of delirium in the intensive care unit: A secondary analysis of the Deli study

Cited by 3 publications

References 74 publications

Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome

Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome

Frailty in the cardiac intensive care unit: assessment and impact

Implications of frailty before and after intensive care unit admission

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