Frailty, Not Age, Best Predicted Recovery from Trauma

Trauma outcomes among the elderly was best determined by the frailty index

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

Some people in their 80s may seem much younger than they actually are, while some in their 70s seem so much older and weaker than their age. When it comes to recovering from trauma, age might not be the best measure of how someone will fare.

Researchers have found that frailty may be a better measure than age to predict outcomes of older trauma patients.

"Stay active to stay fit as you age."

The lead author of this recent study was Bellal Joseph, MD, of the University of Arizona Medical Center in Tucson.

Frailty is defined as a reduced physiological reserve and reduced resistance to stressors, the authors explained. Older people who are frail are typically less likely to bounce back after major health events than heartier elderly people.

There are a variety of frailty assessment tools available for physicians to use, and these have been shown to be good predictors of how well elderly patients will recover from surgery, the study authors explained. Their use among trauma patients, however, has not been assessed. This study set out to determine how well the Frailty Index could predict in-hospital complications and adverse discharge dispositions after trauma.

Adverse discharge dispositions are when patients go to a skilled nursing facility after discharge from the hospital, or when the patient dies.

Dr. Joseph and team enrolled 250 patients, 65 years of age or older, in their study. All came to a single level 1 trauma center between January 2011 and February 2013 after suffering trauma.

The patients, or their closest family member, answered a 50-variable Frailty Index. The tool used was a modified version of the Frailty Index by Searle et al from the Canadian Study of Health and Aging. Patients were asked about a variety of things, such as other health issues, social activities, medications, nutrition and mood. People were determined to be frail if they scored 0.25 or higher on the index.

Of the 250 patients in the study, 110 (44 percent) were determined to be frail.

Of all the patients in the study, 28.4 percent had in-hospital complications, such as issues related to their heart, bleeding, kidneys troubles, infection or a repeat surgery.

More than 37 percent of those who had in-hospital complications were frail, compared with 21.4 percent who were not frail. The most common complications were urinary tract infections and pneumonia (a lung infection).

There was no difference between those who required surgery and those who needed to undergo repeat surgeries.

Frail patients had longer stays in the hospital and intensive care unit. 

Frail patients were also more likely to have adverse discharge dispositions. Five patients in the study died, and all had been determined to be frail.

The authors of this study concluded that using a frailty index may be a useful way to predict how well elderly trauma patients will fare.

"As the geriatric US population rapidly expands, age-related illnesses will significantly impact our healthcare system," Robert Ashton, MD, a board-certified thoracic and general surgeon in New York, told dailyRx News.

"Frailty, which is the decreased physiologic reserve compromising one’s ability to respond to stressors, is a serious condition affecting older individuals. In the study by Joseph et al, a frailty index score was found to be an independent predictor of poor outcomes in geriatric trauma patients. Individuals with a higher score had more complications, longer length of stay and higher mortality," Dr. Ashton noted.

"While this finding is important for treating hospitalized patients by identifying those at the highest risk, it also has broader implications. Individuals caring for the elderly population need to recognize and treat the signs of frailty and its precursor, sarcopenia [degenerative loss of skeletal muscle mass]. Identifying individuals with muscle loss and altered metabolic markers is the first step in the treatment and prevention of frailty. Awareness by health practitioners and family members of geriatric individuals is crucial for both individual patients and the health of our society overall," he said.

In a related commentary on this study, Thomas N. Robinson, MD, MS, of the University of Colorado School of Medicine, and Emily Finlayson, MD, MS, of the University of California, San Francisco, weighed in on their thoughts on the frailty index. They suggested that patients determined as frail could be treated differently to improve outcomes. They also suggested the index could help doctors better decide who could be safely discharged after a fall from standing height.

"Although the best frailty tool for trauma cases has yet to be determined, this study should trigger further research and quality improvement efforts targeting the growing population of trauma patients with frailty," Drs. Robinson and Finlayson wrote.

This study was published online June 11 in JAMA Surgery.

The authors disclosed no potential conflicts of interest.

Review Date: 
June 11, 2014
Last Updated:
June 13, 2014