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

 描述（由申请人提供）：在重症监护室（ICU）接受护理的患者中，老年人占很大比例，而且比例越来越大，许多人在ICU中幸存下来，但出现了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。由于缺乏用于识别危重患者虚弱的测量方法，测试旨在改善老年患者ICU结局的干预措施的能力受到阻碍。一位热衷于将老年医学原理应用于ICU的重症监护医学初级研究人员开发了两种互补的方法来识别重症患者的虚弱。第一种方法使用可以容易地从电子医疗记录获得的临床信息来识别虚弱。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虚弱。这项初步研究的总体目标是前瞻性地测试这两个创新的脆弱性措施的有效性队列危重老年患者。具体目标1将通过比较ICU前虚弱的临床和人口统计学相关性来评估两种虚弱指标的结构有效性。具体目标2将通过比较这两种虚弱指标预测住院死亡率的能力来评价其预测有效性。具体目标3是探索性的，将确定ICU前虚弱与死亡或严重残疾的6个月结局之间的关联。本研究的结果将直接为样本量计算和脆弱性指标提供信息，这些指标将用于测试旨在改善ICU治疗后患者结局的治疗干预措施的大型研究。该项目的实践经验和该奖项将确保的进一步职业发展的保护时间将帮助这位初级研究者过渡到辅导职业发展奖，并将成为研究职业生涯的重要组成部分，重点是改善面临危重疾病的老年患者的结果。

 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.