41 MENTAL FRAILTY IN ICU-SURVIVORS & INFORMAL CAREGIVER STRAIN 3 3.1 INTRODUCTION Mental health-related problems are common in Intensive Care Unit (ICU)- survivors and are often associated with limitations in recovery.1 Over the past decade, the number of patients surviving critical illness has increased due to advances in intensive care medicine.2 Critical illness and admission to the ICU exposes patients to a number of stressors, including but not limited to: invasive medical procedures, delirium, loss of control, unfamiliar surroundings, and the inability to communicate.3 Acombinationof these factors results in a substantial number of ICU-survivors experiencing long-term symptoms of anxiety, depression, and post-traumatic stress disorder.4,5 These mental health-related problems can lead to poor health-related quality of life (HRQoL), the hallmark of the Post-Intensive Care Syndrome (PICS).5 Impaired mental health and other PICS-related health complaints curtail a patient’s chances of meaningful recovery. Long-term non-recovery in ICU- survivors is common6 and results in higher healthcare utilisation and the inability to participate in society.7,8 In addition, long-term impairments pose a high burden on the patient’s informal caregivers, as they often provide informal care. Although the impact of critical illness on relatives and informal caregivers is yet to be fully understood, a large proportion of caregivers experience depressive symptoms, trauma-related problems, and restrictions in daily living over a longer period of time.9,10 Although knowledge on mental health-related recovery is expanding, it is still unclear which patients are in need of additional support. Previous studies on recovery in mental health have predominantly studied the presence of isolated symptoms (e.g. anxiety, depression, or trauma-related problems) rather than relevant composite measures such as frailty, and did not use clinically relevant threshold values.11,12 Using threshold values for symptoms of depression, anxiety, and trauma may provide an indication of long-termmental frailty. Over the last decade, frailty has been introduced as a predominantly physical phenotype associated with aging and reflecting in higher risk of health problems, care needs, and mortality.13 Several frailty indices have been developed to predict morbidity and mortality across the public and clinical health domain. As assessing the frailty phenotype may be troublesome, shorter indices like the clinical frailty scale (CFS) are often used in acute care.14 However, these practical tools do not include a comprehensive assessment of mental health and may therefore be less suitable to assess mental frailty and rehabilitation needs in a long-term care setting. Thus, identifying patients with mental frailty can support the search for useful markers of long-term impairments in mental health.
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