Frailty and emergency surgery: identification and evidence-based care for vulnerable older adults.
Anaesthesia
; 77(12): 1430-1438, 2022 12.
Article
in English
| MEDLINE | ID: covidwho-2136638
ABSTRACT
Frailty is a multidimensional state related to accumulation of age- and disease-related deficits across multiple domains. Older people represent the fastest growing segment of the peri-operative population, and 25-50% of older surgical patients live with frailty. When frailty is present before surgery, adjusted rates of morbidity and mortality increase at least two-fold; the odds of delirium and loss of independence are increased more than four- and five-fold, respectively. Care of the older person with frailty presenting for emergency surgery requires individualised and evidence-based care given the high-risk and complex nature of their presentations. Before surgery, frailty should be assessed using a multidimensional frailty instrument (most likely the Clinical Frailty Scale), and all members of the peri-operative team should be aware of each patient's frailty status. When frailty is present, pre-operative care should focus on documenting and communicating individualised risk, considering advanced care directives and engaging shared decision-making when feasible. Shared multidisciplinary care should be initiated. Peri-operatively, analgesia that avoids polypharmacy should be provided, along with delirium prevention strategies and consideration of postoperative care in a monitored environment. After the acute surgical episode, transition out of hospital requires that adequate support be in place, along with clear discharge instructions, and review of new and existing prescription medications. Advanced care directives should be reviewed or initiated in case of readmission. Overall, substantial knowledge gaps about the optimal peri-operative care of older people with frailty must be addressed through robust, patient-oriented research.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Delirium
/
Frailty
Type of study:
Observational study
/
Prognostic study
Limits:
Aged
/
Humans
Language:
English
Journal:
Anaesthesia
Year:
2022
Document Type:
Article
Affiliation country:
Anae.15860
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