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Cited by 41Palliative Care and End-of-Life IssuesIntensive Care Unit Cognitive DisordersFrailty in Older Adults

The Frailty Phenotype and Palliative Care Needs of Older Survivors of Critical Illness

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Pollack, Lauren R., Goldstein, Nathan E., Gonzalez, Wendy C., Blinderman, Craig D., Maurer, Mathew S., Lederer, David J., Baldwin, Matthew R.·2017·Journal of the American Geriatrics Society
DOI 10.1111/jgs.14799PMC PMC5478496
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Abstract

OBJECTIVES: To assess symptoms in older intensive care unit (ICU) survivors and determine whether post-ICU frailty identifies those with the greatest palliative care needs. DESIGN: A prospective cohort study. SETTING: Urban tertiary care hospital and community hospital. PARTICIPANTS: Medical ICU survivors of mechanical ventilation aged 65 and older (N = 125). MEASUREMENTS: Baseline measurements of the Edmonton Symptom Assessment Scale (ESAS), categorized as mild (0-3), moderate (4-6), and severe (7-10), and the frailty phenotype were made during the week before hospital discharge. Functional recovery was defined as a return to a Katz activity of daily living dependency count less than or equal to the prehospitalization dependency count within 3 months. In the last 29 participants recruited, we made additional assessments of fatigue and ESAS both at baseline and 1 month after discharge. RESULTS: Fatigue was the most-prevalent moderate to severe symptom (74%), followed by dyspnea (53%), drowsiness (50%), poor appetite (47%), pain (45%), depression (42%), anxiety (36%), and nausea (17%). At 1-month follow-up, there were no significant differences in the proportions of participants with moderate to severe symptoms. Each increase in baseline ESAS fatigue severity category was associated with 55% lower odds of functional recovery (odds ratio = 0.45, 95% confidence interval = 0.24-0.84), independent of age, sex, comorbidities, and critical illness severity. Frail participants had a higher median baseline total ESAS symptom distress score (34, interquartile range (IQR) 23-44) than nonfrail participants (13, IQR 9-22) (P < .001). CONCLUSION: Older ICU survivors have a high burden of palliative care needs that persist 1 month after discharge. Fatigue is the most-prevalent symptom and may interfere with recovery. Post-ICU frailty may be a useful trigger for palliative care consultation and a treatment target.

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  • Post-extubation swallowing disorder can be prolonged up to 21 days, mainly in the elderly and after prolonged intubation.

    “This post-extubation swallowing disorder could be prolonged for to up to 21 days mainly in the elderly and after prolonged intubation.”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [311]

    The Introduction and Discussion address outcomes and palliative care needs in older survivors of mechanical ventilation, but do not address post-extubation swallowing disorder. Searches for dysphagia, prolonged intubation, and a 21-day duration found no passage supporting the claim; page numbers were unavailable in our copy. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • At 21 days post-extubation, 24% of older patients were feeding tube dependent.

    “Thus, at 21 days post-extubation, 24% of older patients were feeding tube dependent (311).”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [311]

    The Methods (Measurements; page unavailable) describe ADL dependencies and follow-up at three months, while the Results (Changes in Symptoms at 1 Month; page unavailable) report symptom outcomes. Searches for feeding-tube dependence, 24%, and 21 days post-extubation found no passage reporting the claimed outcome. (LLM, conf=0.76)

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Authors
Pollack, L. R., Goldstein, N. E., Gonzalez, W. C., Blinderman, C. D., Maurer, M. S., Lederer, D. J., & Baldwin, M. R.
Affiliations
  • Columbia University (US)
  • Mount Sinai Beth Israel (US)
Corresponding author
Baldwin, Matthew R.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2017-03-06
Volume
65
Issue
6
Pages
1168-1175
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/jgs.14799
PMC
PMC5478496
OpenAlex
W2592649177
Cited by
41
References
4
Citations by year
2026: 4 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 6 · 2021: 8 · 2020: 6 · 2019: 4 · 2018: 3
FWCI
3.34
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Columbia University Aging Center Faculty Research Fellowships
  • National Institute on Again and AFAR Medical Student Training in Aging Research (LRP)
  • Columbia University College of Physicians and Surgeons Dean's Research Fellowship
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords
Fried frailty phenotype, palliative care needs, critical illness, mechanical ventilation, fatigue, symptom burden, functional recovery, Edmonton Symptom Assessment System, dyspnea, depression, anxiety, palliative care consultation
MeSH terms
Aftercare, Aged, Fatigue, Female, Humans, Intensive Care Units, Male, Palliative Care, Phenotype, Surveys and Questionnaires, Skilled Nursing Facilities, Advance Directives, Frail Elderly, Critical Illness, Survivors, Needs Assessment

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