• Sean M Bagshaw, H Thomas Stelfox, Jeffrey A Johnson, Robert C McDermid, Darryl B Rolfson, Ross T Tsuyuki, Quazi Ibrahim, and Sumit R Majumdar.
• 1Division of Critical Care Medicine (University of Alberta Hospital), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 2Department of Critical Care Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada. 3School of Public Health, University of Alberta, Edmonton, Canada. 4Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 5Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 6EPICORE Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
• Crit. Care Med. 2015 May 1; 43 (5): 973-82.

ObjectiveFrailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality of life among survivors of critical illness.DesignProspective multicenter observational cohort study.SettingICUs in six hospitals from across Alberta, Canada.PatientsFour hundred twenty-one critically ill patients who were 50 years or older.InterventionsNone.Measurements And Main ResultsFrailty was operationalized by a score of more than 4 on the Clinical Frailty Scale. Health-related quality of life was measured by the EuroQol Health Questionnaire and Short-Form 12 Physical and Mental Component Scores at 6 and 12 months. Multiple logistic and linear regression with generalized estimating equations was used to explore the association between frailty and health-related quality of life. In total, frailty was diagnosed in 33% (95% CI, 28-38). Frail patients were older, had more comorbidities, and higher illness severity. EuroQol-visual analogue scale scores were lower for frail compared with not frail patients at 6 months (52.2 ± 22.5 vs 64.6 ± 19.4; p < 0.001) and 12 months (54.4 ± 23.1 vs 68.0 ± 17.8; p < 0.001). Frail patients reported greater problems with mobility (71% vs 45%; odds ratio, 3.1 [1.6-6.1]; p = 0.001), self-care (49% vs 15%; odds ratio, 5.8 [2.9-11.7]; p < 0.001), usual activities (80% vs 52%; odds ratio, 3.9 [1.8-8.2]; p < 0.001), pain/discomfort (68% vs 47%; odds ratio, 2.0 [1.1-3.8]; p = 0.03), and anxiety/depression (51% vs 27%; odds ratio, 2.8 [1.5-5.3]; p = 0.001) compared with not frail patients. Frail patients described lower health-related quality of life on both physical component score (34.7 ± 7.8 vs 37.8 ± 6.7; p = 0.012) and mental component score (33.8 ± 7.0 vs 38.6 ± 7.7; p < 0.001) at 12 months.ConclusionsFrail survivors of critical illness experienced greater impairment in health-related quality of life, functional dependence, and disability compared with those not frail. The systematic assessment of frailty may assist in better informing patients and families on the complexities of survivorship and recovery.

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