Robinson et al identified characteristics that can be used to identify a frail geriatric patient who is more likely to be discharged to an institution following surgery. The authors are from the University of Colorado and Denver Veteran's Affairs Medical Center.

Patietn selection: geriatric patient >= 65 years undergoing major elective surgery and admitted to the ICU after surgery


The features most predictive of frailty and discharge to an institution:

(1) Charlson comorbidity index >= 3

(2) time up-and-go >= 15 seconds (patient is sitting in the chair, stands up, walks 10 feet, returns, and sits down again)

(3) one or more functional impairment(s) (with Katz activity of daily living score <=3)

(4) anemia with hematocrit <= 35%


Additional features:

(1) low serum albumin (< 3.4 g/dL)

(2) cognitive dysfunction (Mini-Cog score <= 3, with normal = 5)

(3) presence of 1 or more falls in the past 6 months


total number of predictive factors =

= SUM(number of items present)



• minimum number of items: 0

• maximum number: 7

• The risk of being institutionalized increases with the number of factors present.


Total Score

Risk of Being Institutionalized

0 or 1


2 or 3


4 or 5


6 or 7



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