[Frailty in intensive care medicine]

Demographic ageing results in a continuous increase in very old patients admitted to intensive care units (ICUs). Chronological age alone is insufficient as a predictor of mortality and functional recovery following critical illness. Frailty, as an expression of biological vulnerability, enables more precise risk stratification.

A systematic literature search was conducted in PubMed (U.S. National Library of Medicine, Bethesda, MD, USA), Scopus (Elsevier, Amsterdam, the Netherlands), and the Web of Science (Clarivate Analytics, Boston, MA, USA), focusing on frailty definition, pathophysiology, assessment instruments, epidemiological data, and clinical management in intensive care medicine.

Frailty is a multidimensional geriatric syndrome with a prevalence of 26.6-43.1% upon ICU admission. The clinical frailty scale (CFS) has established itself as a practical assessment instrument for acute and intensive care medicine. Frailty emerges as a robust independent predictor of increased mortality, ventilator weaning failure, delirium development, and persistent functional dependence. Structured frailty management across the entire patient pathway-including prehabilitation, early mobilization, nutritional support, and specialized rehabilitation-aims to address these functional risks.

Systematic assessment of frailty forms the basis of realistic prognostic evaluation and patient-centered setting of treatment goals (shared decision-making). It enables the identification of high-risk patients who may benefit from targeted function-preserving interventions, serving as a prerequisite for adapted care without directly influencing mortality or functional recovery.