Clinical Frailty in Intensive Care Units: Prevalence and Associated Factors

Frailty is a syndrome characterised by increased sensitivity to stress alongside a reduction in an individual's biopsychosocial reserves. In intensive care patients, frailty is a significant condition that affects mortality and morbidity. However, routine frailty screening and its integration into care plans in intensive care units (ICUs) have not been standardised.

The study aimed to determine the prevalence of frailty in patients hospitalised in an ICU in Türkiye and to examine the factors associated with frailty.

This prospective, observational study was conducted among patients hospitalised in the Anesthesia and Reanimation and General ICUs of a tertiary healthcare facility in Türkiye between January 1 and April 1, 2025. Frailty was assessed using the Clinical Frailty Scale (CFS). Acute Physiology And Chronic Health Evaluation (APACHE II), Nutritional Risk Screening (NRS)-2002, Glasgow Coma Scale (GCS), Body Mass Index (BMI), functional status and sociodemographic data were also recorded. Data were collected through interviews with patients or their legal guardians and through file records. Analyses were conducted using descriptive statistics, non-parametric tests, correlation coefficients and logistic regression.

In total, 149 patients were included in the study. The mean age of the patients was 69.9 ± 15.9 years, and 32.2% were aged ≥ 80 years. According to the CFS, the prevalence of frailty was 82.6%. Frailty was significantly associated with older age, male sex, low BMI, NRS-2002, functional decline, high APACHE II score, prolonged duration of mechanical ventilation and mortality (p < 0.05). The duration of mechanical ventilation was significantly longer in frail patients. Death from the ICU was significantly higher in frail patients. In logistic regression analysis, age (OR = 1.03, 95% CI, 1.00-1.06), male sex (OR = 2.96, 95% CI, 1.09-8.07), APACHE II (OR = 1.11, 95% CI, 1.03-1.19) and NRS-2002 (OR = 2.09, 95% CI, 1.06-4.09) were found to be independent predictors of frailty.

Frailty was highly prevalent among ICU patients and was significantly associated with several clinical and demographic factors negatively affecting prognosis, including prolonged mechanical ventilation and increased ICU mortality. Results suggest that routinely assessing frailty and integrating it into nursing care is critical for preventing complications and improving patient outcomes.

This study suggests that early, systematic frailty screening in ICUs will contribute to the identification of at-risk patients and the development of individualised nursing care plans. Intensified nursing monitoring is recommended, particularly for patients with advanced age, male sex, low BMI and nutritional risk. Using frailty assessments in conjunction with traditional scores such as the APACHE II will enhance the prediction of mortality risk and improve patient safety.