Frailty, CPR and Risk of Death: Study Uncovers Important Connections
For many hospitalized, older adults and their loved ones, choosing whether to undergo or forgo cardiopulmonary resuscitation (CPR) is a difficult decision, fraught with uncertainty. Researchers from the Brigham’s Division of Aging and Department of Medicine conducted a study to help clinicians, patients and families better understand the connection between frailty among older adults and the most likely outcome after CPR. Dr. Frances Y. Hu is the study’s lead author. She told us more about her team’s study and findings in this Q&A:
Q: What are your paper’s key findings?
A: We showed that higher levels of frailty, measured according to Clinical Frailty Scale, are associated with increased mortality following cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest in older adults in the United States.
Q: What do you want the public to know about frailty, CPR, and risk of death?
A: Frailty has increasingly been used as a prognostic tool for increased risk of adverse health outcomes, such as mortality or complications. Our study measured frailty using the Clinical Frailty Scale, a tool readily applied in clinical practice. Based on a quick and reliable clinical assessment of frailty, clinicians may have more evidence surrounding the risk of death following CPR for an individual patient. Independent of age alone, the risk of death varies greatly based on a patient’s level of frailty, and this information may be used to guide decision-making.
Q: What questions remain unanswered?
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A: We would be interested in exploring how frailty affects additional clinical and patient-centered outcomes after in-hospital CPR, ranging from cognitive status to days spent at home. These outcomes would provide further insight into the relationship between the difficult decision to undergo CPR and goal-concordant care for older patients.
Q: Moving forward, what types of conversations would you like for clinicians to have with patients and their families regarding frailty and mortality in the context of cardiac arrest?
A: Using these findings, we encourage clinicians to incorporate frailty as a factor in discussions with patients and their families about goals of care, specifically cardiopulmonary resuscitation. Rather than making recommendations based on a frailty level threshold, we suggest framing frailty in the larger context of a patient’s baseline health and quality of life when having these nuanced conversations. Goals of care discussions would ideally take place in an outpatient setting, yet the ability to perform bedside frailty assessment allows these discussions to be conducted or revisited, if necessary, in the acute setting.
To read Dr. Hu’s full paper, visit:
Registered Nurse at Brigham and Women's Hospital
2yIn my long experience as an E.D. nurse, E.D. Residents as well as Attending Physicians often have trouble communicating with family members when an elderly patient at end of life, or say someone who was brought in from a hospice situation who is not doing well and CPR becomes an issue. When these patients arrive, even when they have DNR status, family's are not ready to say goodbye and often want full CPR measures done on their loved ones. It's difficult at times for clinicians; doctors and nurse to talk to loved ones about the effects CPR will have on the patient. To have teaching sessions with clinicians to assist with communicating to family's and loved ones on how to approach these situations would be invaluable.