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07 October 2019
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Frail patients make up almost 40% of those aged 80 years or over in Australian and New Zealand intensive care units, and are more than twice as likely to die as non-frail patients, according to a Royal Melbourne Hospital and Australian and New Zealand Intensive Care Society-led research paper published today in the Medical Journal of Australia.

Frail patients were also found to be more frequently discharged to a new nursing home or chronic care admission than non-frail patients.

The findings have implications for the Australian health care system going forward, according to lead author Dr Jai Darvall, an anaesthetist and intensive care specialist at the Royal Melbourne Hospital and the University of Melbourne’s Centre for Integrated Critical Care.

“We found that frailty is prevalent among critically ill patients aged 80 years or more in Australia and New Zealand, and that it is associated with doubled rates of in-hospital mortality and discharge to residential care,” Dr Darvall said.

“That the risk of new residential care admission is 1.6 times as high for frail as for non-frail very old patients suggests that recovery from critical illness is worse for frail patients.”

“These are findings with major implications for health care and community resource planning.”

Dr Darvall and his colleagues analysed data from 15,613 patients aged 80 years or older who were admitted to 178 intensive care units across Australia and New Zealand between 1 January 2017 and 31 December 2018.

Of these patients, 6203 (39.7%) were deemed to be frail – frailty being a multidimensional syndrome characterised by “reduced capacity to deal with external stressors”. 18% of frail vs. 8% of non-frail patients died in hospital.

The study also found that frail patients were more frequently admitted from the emergency department (28% v 21%) or with sepsis (12% v 7%) or respiratory complications (16% v 12%) compared to non-frail patients.

Dr Darvall said that with the number of patients aged 80 years or more in Australian ICUs expected to increase in the future, the findings of the study will be important for intensive care and community health care planning.

“By 2030, more than one-quarter of patients in Australian ICUs are forecast to be aged 80 years or more,” Dr Darvall said.

“Routine screening of older ICU patients for frailty could improve outcome prediction, and help inform intensive care and community planning for discharge.”

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