Geriatric Physiology and the Frailty Syndrome

Khan, Kashif; Hemati, Kaveh; Donovan, Anne L.

doi:10.1016/j.anclin.2019.04.006

Cited by 67 publications

(42 citation statements)

References 124 publications

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“…With the rapidly ageing population, frailty in surgery is fast becoming an exciting field of interest and research. This comes with the recognition that chronological and biological age in a patient can vary and can significantly influence surgical outcomes [7]. One of the current challenges is the diagnosis and assessment of frailty.…”

Section: Discussionmentioning

confidence: 99%

Frailty in Elderly Gastric Cancer Patients Undergoing Gastrectomy

et al. 2020

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Introduction: There is a dearth of literature on frailty specifically in elderly (aged ≥65 years) gastric cancer patients undergoing gastrectomy. We aim to assess the effects of frailty on postoperative outcomes. Methods: A review of a prospective database was performed from November 2011 to April 2019. Frailty was assessed by multidimensional frailty score (MFS). Outcomes assessed were early postoperative complications and mortality, and length of stay. Results: 289 patients were included. The mean age was 77.3 (range 66–94) years. 183 (63.3%) were males and 172 (59.5%) had early cancer. 275 (95.2%) underwent minimally invasive gastrectomy. 79 (27.3%) patients suffered early postoperative complications, with 47 (16.3%) suffering from Clavien-Dindo grade ≥2 complications. One-year, 90-day, 30-day, and inhospital mortality were 6.6, 1.4, 0.7, and 0%, respectively. 111 (38.4%) of patients were classified as “frail” based on MFS > 5. “Frail” patients were associated with higher 1-year mortality (odds ratio (OR) 4.51, 95% CI 1.57–12.98, p = 0.005) on univariate analysis. On multivariate analysis, “frail” patients did not have significantly increased 1-year mortality. However, when definition of “frail” was changed from MFS > 5 to MFS > 6, frailty was significantly associated with increased 1-year mortality (OR 3.73, 95% CI 1.11–12.53, p = 0.033). Conclusions: Elderly gastric cancer patients undergoing gastrectomy with MFS > 5 do not have increased mortality risk. The influence of frailty on postoperative outcomes may vary based on the risk of the surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Frailty in Elderly Gastric Cancer Patients Undergoing Gastrectomy

et al. 2020

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“…The geriatric field has represented the main area of investigation on such status [21], but different specialties have adapted frailty assessment into their clinical practice. With regard to surgery, various scoring systems were employed, demonstrating a strong association between a frail profile and increased length of stay, postoperative complications, mortality rates and discharge to rehabilitation facilities [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Lucarini

Sganga²,

Agresta

et al. 2020

Aging Clin Exp Res

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Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.

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“…There are numerous definitions of frailty as well as measurements suggesting that we really do not know what it is, as with the various measurements we are capturing just one aspect of it (Theou et al, 2013;Malmstrom et al, 2014;Mijnarends et al, 2015). It is clear that if we refer to the basic definition of frailty as the loss of the body's reserves leading to a decreased resilience and consequently to adverse events, we are just giving the physiological definition of aging (Fulop et al, 2010;Khan et al, 2019). Together this would signify a failure of the homeodynamic maintenance of system functions (Rattan, 2015).…”

Section: How Geroscience and Frailty Are Integrated In The Notion Thamentioning

confidence: 99%

Are We Ill Because We Age?

et al. 2019

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Growing elderly populations, sometimes referred to as gray (or silver) tsunami, are an increasingly serious health and socioeconomic concern for modern societies. Science has made tremendous progress in the understanding of aging itself, which has helped medicine to extend life expectancies. With the increase of the life expectancy, the incidence of chronic age-related diseases (ARDs) has also increased. A new approach trying to solve this problem is the concept of geroscience. This concept implies that the aging process itself is the common cause of all ARDs. The corollary and consequence of such thinking is that we can and should treat aging itself as a disease. How to translate this into the medical practice is a big challenge, but if we consider aging as a disease the problem is solved. However, as there is no common definition of what aging is, what its causes are, why it occurs, and what should be the target(s) for interventions, it is impossible to conclude that aging is a disease. On the contrary, aging should be strongly considered not to be a disease and as such should not be treated; nonetheless, aging is likely amenable to optimization of changes/adaptations at an individual level to achieve a better functional healthspan.

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Geriatric Physiology and the Frailty Syndrome

Cited by 67 publications

References 124 publications

Frailty in Elderly Gastric Cancer Patients Undergoing Gastrectomy

Frailty in Elderly Gastric Cancer Patients Undergoing Gastrectomy

The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Are We Ill Because We Age?

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