• Lauren R Pollack, Nathan E Goldstein, Wendy C Gonzalez, Craig D Blinderman, Mathew S Maurer, David J Lederer, and Matthew R Baldwin.
• Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York.
• J Am Geriatr Soc. 2017 Jun 1; 65 (6): 1168-1175.

ObjectivesTo assess symptoms in older intensive care unit (ICU) survivors and determine whether post-ICU frailty identifies those with the greatest palliative care needs.DesignA prospective cohort study.SettingUrban tertiary care hospital and community hospital.ParticipantsMedical ICU survivors of mechanical ventilation aged 65 and older (N = 125).MeasurementsBaseline measurements of the Edmonton Symptom Assessment Scale (ESAS), categorized as mild (0-3), moderate (4-6), and severe (7-10), and the frailty phenotype were made during the week before hospital discharge. Functional recovery was defined as a return to a Katz activity of daily living dependency count less than or equal to the prehospitalization dependency count within 3 months. In the last 29 participants recruited, we made additional assessments of fatigue and ESAS both at baseline and 1 month after discharge.ResultsFatigue was the most-prevalent moderate to severe symptom (74%), followed by dyspnea (53%), drowsiness (50%), poor appetite (47%), pain (45%), depression (42%), anxiety (36%), and nausea (17%). At 1-month follow-up, there were no significant differences in the proportions of participants with moderate to severe symptoms. Each increase in baseline ESAS fatigue severity category was associated with 55% lower odds of functional recovery (odds ratio = 0.45, 95% confidence interval = 0.24-0.84), independent of age, sex, comorbidities, and critical illness severity. Frail participants had a higher median baseline total ESAS symptom distress score (34, interquartile range (IQR) 23-44) than nonfrail participants (13, IQR 9-22) (P < .001).ConclusionOlder ICU survivors have a high burden of palliative care needs that persist 1 month after discharge. Fatigue is the most-prevalent symptom and may interfere with recovery. Post-ICU frailty may be a useful trigger for palliative care consultation and a treatment target.© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

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