Utility of Frailty Screening Tools in Older Surgical Patients

Abstract

tion. 4) An observational study showed a poor prognosis for functional recovery among older patients hospitalized for acute medical illness and discharged with a new or additional disability. Identifying these patients early enables clinicians to provide intensive rehabilitation interventions, caregiver support, or consideration of palliative care. 5) For example, before surgical intervention, identifying frailty may facilitate early rehabilitation to improve the likelihood of recovery. It may also be appropriate to counsel frail patients against surgery or offer palliation if there is a high risk of complications, including dependence and mortality. This paper provides an overview of frailty and frailty screening tools and suggests an approach that incorporates a frailty scale in preoperative assessments for older surgical patients to identify those who may benefit from early intervention and rehabilitation. FRAILTY The Asia-Pacific Clinical Practice Guideline indicates that frailty can be identified through three approaches, namely the Fried

The degree of frailty as a translational measure of health in aging

“…In 2001, several papers proposed new operational approaches to frailty [41][42][43] . Since then, although many frailty tools have been developed, two approaches have predominated (Table 1) [44][45][46] . One sees frailty as conforming to a phenotype or syndrome that underscores physical decline: low levels of grip strength, slow walking speed, loss of weight, reduction in usual activities and feeling exhausted; any three of these five features define a person as frail 41 .…”

“…Indeed, a higher degree of frailty has been linked to a greater risk of disability in activities of daily living and falls 75,76 , delirium [77][78][79] , as well as more hospital admissions, with longer lengths of stay 75,80 , and more primary care visits-all leading to greater health care costs 73,81 . Work on the degree of frailty and risk extends to a variety of clinical settings, including critical care 5 , during invasive interventions 46 and in nursing homes 82 .…”

“…Context matters, and especially in relation to excluding older adults who live with frailty; informative context also extends to social and economic settings 137,138 , race 13,86,139 the clinical setting 5,46,82,86,140 , childhood influences 141 , and cohort and period effects 13,[142][143][144][145][146] .…”

Chronic Lower Extremity Ischemia and Its Association with the Frailty Syndrome in Patients with Diabetes

“…Taken together, it is a high priority to define optimal tool to assess Frailty in clinical practice and to determine cutoff value [ 113 ]. Poh and Teo presented an interesting analysis of the available tools for assessing the severity of Frailty in the elderly undergoing surgical treatment and proposed an algorithm for their use, which, however, must still be validated [ 114 ].…”

Delirium in Frail Older Adults

“… 44 , 60 , 63 ) Surgery is one specialty that has been actively incorporating frailty assessment in routine preoperative evaluations. 64 ) In orthopedic surgery, Krishnan et al 65 ) explored the use of a frailty index that was integrated into a comprehensive geriatric assessment for hip fracture patients. More specific frailty assessment tools based on the patient population have also been validated, including the 15-item Trauma-Specific Frailty Index for trauma patients and the 15-variable Emergency General Surgery Specific Frailty Index for patients undergoing emergent surgeries.…”