• Christian Jung, Raphael Romano Bruno, Bernhard Wernly, Georg Wolff, Michael Beil, and Malte Kelm.
• Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Faculty of Medicine, Düsseldorf University Hospital; Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Intensive Care Medicine, Hadassah-Hebrew University Hospital, Jerusalem, Israel; Cardiovascular Research Institute Düsseldorf (CARID).
• Dtsch Arztebl Int. 2020 Oct 2; 117 (40): 668673668-673.

BackgroundThe percentage of patients in intensive care who are 80 years old or older is continually increasing. Such patients already made up more than 20% of all patients in intensive care in Germany in the years 2007-2011. Meanwhile, effective treatments that support the organs of the body and keep severely ill patients alive are also being continually developed and refined. Frailty is a key prognostic parameter. The scientifically based assessment of frailty can be highly useful in intensive care medicine with regard to consented decision-making, individualized prognostication, treatment planning, and aftercare.MethodsPertinent publications were retrieved by a selective search in the PubMed database. On the basis of the literature assessment, a variety of screening instruments were used to assess frailty and its significance for very old, critically ill patients in German intensive care units.ResultsOnly a small number of screening instruments are suitable for routine use in German intensive care units. The scores vary in diagnostic precision. The Clinical Frailty Scale (CFS) enables highly accurate prognostication; it considers the patient in relation to his or her social environment, and to the reference population. Categorization is achieved by means of pictograms that are supplemented with brief written descriptions. The CFS can be used prospectively and is easy to learn. Its interrater reliability is high (weighted Cohen's κ: 0.85 [0.84; 0.87]), and it has been validated for routine use in intensive care units in Germany.ConclusionNone of the available scores enable perfect prognostication. In Germany, frailty in intensive-care patients is currently best assessed on a simple visual scale (CFS).

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