Frailty Assessment in the Intensive Care Unit and Short Term Outcomes in Older Patients (FRAIL-STOOP)

 描述(由申请人提供)：在重症监护病房(ICU)接受护理的患者中，老年人占很大比例，而且比例不断上升，许多人在ICU中幸存下来，并伴有新的身体或认知障碍。虚弱是一种与年龄或疾病相关的生理储备下降的综合征，可能是ICU治疗后不良结局的重要危险因素。由于缺乏识别危重患者脆弱性的测量方法，测试旨在改善老年患者ICU结局的干预措施的能力受到了阻碍。一位重症监护医学的初级研究员，热衷于将老年学原理应用于ICU，开发了两种互补的方法来识别危重患者的虚弱。第一种方法使用可以很容易从电子病历中获得的临床信息来识别脆弱性。第二种方法使用可用于患者或其代理人的评估工具来识别脆弱性。这项先导性研究的总体目标是前瞻性地在危重老年患者队列中测试这两种创新脆弱措施的有效性。具体目标1将通过比较ICU前脆弱性的临床和人口学相关因素来评估这两种脆弱性测量的结构效度。具体目标2将通过比较这两个脆弱指标预测医院死亡率的能力来评估它们的预测有效性。具体目标3是探索性的，将确定ICU前的脆弱性与死亡或严重残疾的六个月结局之间的联系。这项研究的结果将直接为样本量计算和脆弱性测量提供信息，用于测试旨在改善ICU治疗后患者结局的治疗干预措施的更大规模研究。来自该项目的实践经验和该奖项将确保的进一步职业发展的受保护时间将有助于这位初级研究员向指导职业发展奖过渡，并将成为专注于改善面临危重疾病的老年患者的结果的研究生涯的重要基石。

 DESCRIPTION (provided by applicant): Older adults account for a large and increasing proportion of the patients cared for in Intensive Care Units (ICUs) and many survive the ICU with new physical or cognitive impairments. Frailty, a syndrome of age- or disease-related declines in physiologic reserve may be an important risk factor for adverse outcomes after ICU treatment. The ability to test interventions geared to improving ICU outcomes in older patients has been hampered by the lack of measurement approaches for identifying frailty in critically ill patients. A junior investigator in Critical Care Medicine, with a passion for applying geriatric principles into the ICU, has developed two complementary approaches for identifying frailty in critically ill patients. The first approach identifies frailty using clinical information that can e easily obtained from the electronic medical record. The second approach identifies frailty using an assessment tool that can be administered to patients or their surrogates. The overall goal of this pilot study is to test prospectively the validity of these two innovative frailty measures in cohort of critically ill older patients. Specific Aim 1 will evaluate the construct validity of thetwo frailty measures by comparing the clinical and demographic correlates of pre-ICU frailty. Specific Aim 2 will evaluate the predictive validity of these two frailty measures by comparing their ability to predict hospital mortality. Specific Aim 3 is exploratory and will determine the association between pre-ICU frailty and the six-month outcome of death or severe disability. The results from this study will directly inform the sample size calculation and the frailty measure to be used in larger studies testing therapeutic interventions geared towards improving patient outcomes after ICU treatment. The practical experience from this project and the protected time for further career development that this award will secure will help this junior investigator transition towards a Mentored Career Development Award and will be an important building block towards a research career focused on improving outcomes for older patients facing critical illness.