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

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Title: The Frailty Phenotype and Palliative Care Needs of Older Survivors of Critical Illness.
Authors: Pollack, Lauren R., Goldstein, Nathan E., Gonzalez, Wendy C., Blinderman, Craig D., Maurer, Mathew S., Lederer, David J., Baldwin, Matthew R.
Source: Journal of the American Geriatrics Society. Jun2017, Vol. 65 Issue 6, p1168-1175. 8p. 1 Diagram, 2 Charts, 2 Graphs.
Subjects: Frail elderly, Palliative treatment, Intensive care patients, Older patients, Human phenotype, Critically ill patient care, Symptoms, Activities of daily living scales, Health, Catastrophic illness, Confidence intervals, Longitudinal method, Phenotypes, Activities of daily living, Odds ratio
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. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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DbLabel: Psychology and Behavioral Sciences Collection
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  Data: The Frailty Phenotype and Palliative Care Needs of Older Survivors of Critical Illness.
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– Name: Abstract
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  Data: 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 &lt; .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. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=123692386
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/jgs.14799
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 1168
    Subjects:
      – SubjectFull: Frail elderly
        Type: general
      – SubjectFull: Palliative treatment
        Type: general
      – SubjectFull: Intensive care patients
        Type: general
      – SubjectFull: Older patients
        Type: general
      – SubjectFull: Human phenotype
        Type: general
      – SubjectFull: Critically ill patient care
        Type: general
      – SubjectFull: Symptoms
        Type: general
      – SubjectFull: Activities of daily living scales
        Type: general
      – SubjectFull: Health
        Type: general
      – SubjectFull: Catastrophic illness
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Phenotypes
        Type: general
      – SubjectFull: Activities of daily living
        Type: general
      – SubjectFull: Odds ratio
        Type: general
    Titles:
      – TitleFull: The Frailty Phenotype and Palliative Care Needs of Older Survivors of Critical Illness.
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            NameFull: Goldstein, Nathan E.
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            NameFull: Gonzalez, Wendy C.
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              M: 06
              Text: Jun2017
              Type: published
              Y: 2017
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              Value: 65
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