Basic Presentation on Frailty in a Clinical Context

1. Frailty and Its Impact on
Treatment Outcomes
ROHAN PHILIP (FY1)

2. Introduction

3. What is Frailty?
 Physiological reserve to withstand and survive acute ‘stressor events’
 Manifestations of frailty/frailty syndromes:
 Falls
 Immobility
 Delirium
 Incontinence
 Susceptibility to medications

4. Why Is it Important?
 Proportion of frail people are increasing (1)

5. NICE Guidelines in COVID-19(1)

6. Clinical Frailty Score (CFS)

7. Does Frailty Affect Treatment
Outcomes
 Frailty could be helpful in predicting short-term adverse outcomes in
patients admitted with COVID-19 (3)
 In this study, odds for 7-day mortality increased, by CFS group in
observational data from the UK (3)
 Frailty in critical care is associated with increased mortality and higher
likelihood of discharge to another institution (4)

8. Limitations and Caveats (1)
 Pre-COVID, those with frailty (by CFS standards) were frequently offered
critical care treatments
 Canadian Metanalysis: 30%(4)
 Retrospective ANZ Study – 39.7(5)
 Good Outcomes?: (5)
 88% survived to hospital discharge
 55% were discharged to their own homes and a further
 24% were discharged to a rehabilitation facility

9. Limitations and Caveats (2)
 Significant Limitation: incongruence between assessors(6)

10. Is It Appropriate to Ration Care Based
on Frailty?
 Frailty is distributed across socioeconomic gradients(7)
 Environmental factors and social determinants shape health in old age

11. Conclusion
 If used appropriately, the use of CFS will contribute to shared decision-
making based on the likelihood of short-term survival
 One major limitation of the CFS, as applied in the current NICE guideline,
is that it has the potential to reinforce established patterns of inequality
 More informative and less discriminatory than chronological age alone

12. Suggestions for Future Projects
 Potential audit of compliance in Nervecentre Rockwood Score entries/TEP
form completion

13. References
1. COVID-19 rapid guideline: Managing COVID-19 - The National Institute for Health and Care
Excellence (NICE)
2. Rockwood K, Song X, MacKnight C et al. ‘A global clinical measure of fitness and frailty in elderly
people’ CMAJ 2005 (173) pg: 489-95
3. Hewitt J, Carter B, Vilches-Moraga A et al. ‘The effect of frailty on survival in patients with COVID-
19 (COPE): a multicentre, European, observational cohort study Lancet Public Health 2020; 1–8
4. Muscedere, J., Waters, B., Varambally, A., Bagshaw, S.M., Boyd, J.G., Maslove, D., Sibley, S. and
Rockwood, K., 2017. The impact of frailty on intensive care unit outcomes: a systematic review and
meta-analysis. Intensive care medicine, 43(8), pp.1105-1122.
5. Darvall, J.N., Bellomo, R., Paul, E., Subramaniam, A., Santamaria, J.D., Bagshaw, S.M., Rai, S., Hubbard,
R.E. and Pilcher, D., 2019. Frailty in very old critically ill patients in Australia and New Zealand: a
population‐based cohort study. Medical Journal of Australia, 211(7), pp.318-323.
6. Pugh, R.J., Battle, C.E., Thorpe, C., Lynch, C., Williams, J.P., Campbell, A., Subbe, C.P., Whitaker, R.,
Szakmany, T., Clegg, A.P. and Lone, N.I., 2019. Reliability of frailty assessment in the critically ill: a
multicentre prospective observational study. Anaesthesia, 74(6), pp.758-764.
7. Lang, I.A., Hubbard, R.E., Andrew, M.K., Llewellyn, D.J., Melzer, D. and Rockwood, K., 2009.
Neighborhood deprivation, individual socioeconomic status, and frailty in older adults. Journal of
the American Geriatrics Society, 57(10), pp.1776-1780.