Surrogate Assessment of Frailty using Electronic Tools (SAFE-T)
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PROJECT SUMMARY Each year, ~1 million Americans survive a critical illness only to suffer with new-onset frailty. This accelerated, catastrophic, critical illness-associated form of frailty is an emerging, costly, and age-related public health problem that is driven by the growing number of survivors of critical illness, the aging U.S. population, and the ongoing COVID-19 pandemic. Little is known about critical illness-associated frailty. The lack of systematic knowledge of critical illness-associated frailty makes it difficult to propose and test potential interventions. We propose to validate questionnaire-based frailty assessment methods needed to identify those with baseline (i.e., pre-critical illness) frailty, leading directly to a new generation of interventions to manage and mitigate critical illness-associated frailty, ultimately improving the long-term health for older adults surviving critical illness. We hypothesize that questionnaire-based frailty assessments will demonstrate strong reliability and validity as compared to performance-based methods. Upon completion of this study, we will have validated questionnaire-based frailty assessments that can be used when performance-based frailty assessments are not possible—an important next step in our work to understand and intervene upon critical illness-associated frailty. Aim 1: Determine the validity and reliability of patient responses on questionnaire-based frailty assessments with performance-based frailty assessments. Aim 2: Determine the validity and reliability of surrogate responses on questionnaire-based frailty assessments with performance-based frailty assessments. The study of critical illness-associated frailty is in its infancy; our project is therefore intrinsically innovative. Additional innovation arises from our systematic and rigorous frailty measurements using performance-based assessments and questionnaire responses from both patients and their carefully selected surrogates. This is the first study to conduct systematic measurement of questionnaire-based frailty assessments in relation to performance-based frailty assessments in those with critical illness. We will address key barriers needed to guide our approach to intervention, giving this project broad significance. To date, pre-critical illness frailty has been measured by judgement-based tools. Rigorous and objective measurements of frailty are needed to understand etiologies, risk factors, and to guide interventions. Regardless of outcome, results will improve the health of millions of older adult survivors of critical illness by identifying the extent to frailty is present at ICU admission facilitating the study of trajectories, risk factors, and mechanisms of a common, costly, and preventable condition—critical illness-associated frailty.
