The evidence available suggests that deprescribing interventions in hospital are feasible, generally effective at reducing PIMs and safe. However, the current evidence is limited, of low quality and the impact on clinical outcomes is unclear.

The management of frail older people is a key component of aged care. There has been a plethora of tools developed for the diagnosis and screening of frailty. Some of these tools are entering routine clinical practice at a time when the higher healthcare costs involved in caring for older people who are frail have become a potential target for cost-cutting. Yet there is still only limited evidence to support the widespread adoption of frailty tools, and foundational factors impact on their accuracy and validity. Despite the acceptance of frailty as a valid term in research and clinical practice, older people believe the term carries stigma. Such issues indicate that there may be a need to reconsider current approaches to frailty. Recent advances in the science of ageing biology can provide a new framework for reconfiguring how we screen, diagnose, treat and prevent frailty. Frailty can be considered to be a multisystem ageing syndrome of decreased physiological and functional reserve, where the biological changes of ageing are seen in most tissues and organs and are the pathogenic mechanism for frailty. Likewise age-related chronic disease and multimorbidity are syndromes where ageing changes occur in one or multiple systems, respectively. This model focusses diagnostic criteria for frailty onto the biomarkers of ageing and generates new targets for the prevention and treatment of frailty based on interventions that influence ageing biology.

Background Frailty in older vascular surgery patients is associated with increased mortality, hospital stay, and morbidity. The association of frailty with hospital‐acquired geriatric syndromes such as delirium and functional decline has not been well studied. Objectives To investigate the association between frailty and hospital‐acquired geriatric syndromes in older hospitalized vascular surgery patients, and to evaluate the prognostic performance of the frailty index (FI) and the Clinical Frailty Scale (CFS) for delirium and functional decline. Design Prospective cohort study. Setting Acute care academic hospital. Participants Patients aged 65 years or more admitted to a tertiary vascular surgery unit (N=150). Measurements Frailty was assessed using the FI and CFS. The adjusted association of frailty status with delirium and functional decline was assessed using logistic regression analysis. The prognostic performance of FI and CFS was determined by assessing C‐statistic and positive and negative predictive values (PPV and NPV). Results Of 150 participants, FI identified 34 (23%) and CFS identified 45 (30%) as frail. Frailty was an independent predictor of delirium (FI adjusted odds ratio, odds ratio (OR) = 5.66, 95% confidence interval (CI) = 1.53–21.03; CFS adjusted OR = 4.07, 95% CI = 1.14–14.50), but not functional decline. FI and CFS showed acceptable prognostic performance for delirium (C‐statistic 0.74), but not functional decline (C‐statistic 0.63–0.64). For both outcomes, the FI and CFS had high NPV (86–96%), and low PPV (22–29%). Conclusion Frail older vascular surgery patients are more likely to develop hospital‐acquired geriatric syndromes. The FI and CFS have acceptable prognostic performance for predicting delirium but not all individuals who are identified as frail develop delirium. Ongoing research is needed to identify interventions that improve outcomes in patients who screen positive for frailty.